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Testing the leadership and organizational change for implementation (LOCI) intervention in substance abuse treatment: a cluster randomized trial study protocol
Open accessAbstract
BACKGROUND: Evidence-based practice (EBP) implementation represents a strategic change in organizations that requires effective leadership and alignment of leadership and organizational support across organizational levels. As such, there is a need for combining leadership development with organizational strategies to support organizational climate conducive to EBP implementation. The leadership and organizational change for implementation (LOCI) intervention includes leadership training for workgroup leaders, ongoing implementation leadership coaching, 360° assessment, and strategic planning with top and middle management regarding how they can support workgroup leaders in developing a positive EBP implementation climate. METHODS: This test of the LOCI intervention will take place in conjunction with the implementation of motivational interviewing (MI) in 60 substance use disorder treatment programs in California, USA. Participants will include agency executives, 60 program leaders, and approximately 360 treatment staff. LOCI will be tested using a multiple cohort, cluster randomized trial that randomizes workgroups (i.e., programs) within agency to either LOCI or a webinar leadership training control condition in three consecutive cohorts. The LOCI intervention is 12 months, and the webinar control intervention takes place in months 1, 5, and 8, for each cohort. Web-based surveys of staff and supervisors will be used to collect data on leadership, implementation climate, provider attitudes, and citizenship. Audio recordings of counseling sessions will be coded for MI fidelity. The unit of analysis will be the workgroup, randomized by site within agency and with care taken that co-located workgroups are assigned to the same condition to avoid contamination. Hierarchical linear modeling (HLM) will be used to analyze the data to account for the nested data structure. DISCUSSION: LOCI has been developed to be a feasible and effective approach for organizations to create a positive climate and fertile context for EBP implementation. The approach seeks to cultivate and sustain both effective general and implementation leadership as well as organizational strategies and support that will remain after the study has ended. Development of a positive implementation climate for MI should result in more positive service provider attitudes and behaviors related to the use of MI and, ultimately, higher fidelity in the use of MI. TRIAL REGISTRATION: This study is registered with Clinicaltrials.gov ( NCT03042832 ), 2 February 2017, retrospectively registered.
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“Rigorous assessment of implementation leadership is critical to inform implementation research and practice in this domain as recent studies have shown that implementation leadership is a malleable organizational characteristic [28].”
From Leading the charge in the education sector: development and validation of the School Implementation Leadership Scale (SILS) (2022) · cites this paper as [28]
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“Existing leadership-focused implementation strategies, such as Leadership and Organizational Change for Implementation (LOCI) [28] or iLead [93] also likely have utility for promoting implementation leadership behaviors among principals and other school building-level leaders.”
From Leading the charge in the education sector: development and validation of the School Implementation Leadership Scale (SILS) (2022) · cites this paper as [28]
In the citing paper
“In addition, to the developed implementation model and implementation strategy, EPIS was used to code qualitative data and select quantitative survey measures.”
From Ten recommendations for using implementation frameworks in research and practice (2020) · cites this paper as [55]
In the citing paper
“The Leadership and Organizational Change for Implementation (LOCI) intervention employed the EPIS framework to select key implementation determinants to test in a large cluster RCT [55].”
From Ten recommendations for using implementation frameworks in research and practice (2020) · cites this paper as [55]
In the citing paper
“In this study, implementation leadership from first-level team leaders/managers, organizational climate and culture, implementation climate, and psychological safety climate were selected as determinants to test their influence on the fidelity of the EBP being implemented.”
From Ten recommendations for using implementation frameworks in research and practice (2020) · cites this paper as [55]
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Items 101–160 of 160
Huang, X., Wang, C., Lu, L., Chen, J., Wang, R., Feng, Y., Dong, Y., & Zhou, H. (2025) · Frontiers in Medicine · doi:10.3389/fmed.2025.1631810 · Cited by 7
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“…implementation processes could be paired with motivational enhancement strategies 50 to enhance provider buy-in (intervention level) and leadership-focused implementation strategies 51,52 to promote engaged leadership support (practice setting level), building a strong foundation for sustainment.”
Zhang, Y., Larson, M. F., Ehrhart, M. G., King, K. M., Locke, J. J., Cook, C. R., & Lyon, A. R. (2024) · Implementation Science · doi:10.1186/s13012-024-01364-w · Cited by 6
“For instance, leadership-focused implementation strategies (e.g., Leadership and Organizational Change for Implementation, LOCI; [68]) could be used at CBOs to improve their implementation context factors which are more closely related to the implementation outcomes of integrated care than those in…”
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Sklar, M., Hatch, M. R., & Aarons, G. A. (2018) · Journal of Evaluation in Clinical Practice · doi:10.1111/jep.13050 · Cited by 3
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Crable, E. L., Sklar, M., Kandah, A., Samuels, H. C., Ehrhart, M. G., Aalsma, M. C., Hulvershorn, L. A., Willging, C. E., & Aarons, G. A. (2024) · Journal of Substance Use and Addiction Treatment · doi:10.1016/j.josat.2024.209433 · Cited by 6
“First-level leaders worked with the LOCI-SL team to co-create leadership development plans that consisted of evolving goals targeting multiple dimensions of transformational leadership, implementation leadership, and implementation climate (Aarons et al., 2017).”
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“To support the implementation, the clinics participated in the Leadership and Organizational Change for Implementa - tion (LOCI) strategy (Aarons et al., 2017 , 2024; Egeland et al., 2019; Williams et al., 2023).”
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“Such leadership behaviors are modifiable and interventions to improve transformational leadership behaviors among mental health and substance use providers have been successful in clinical trials (Aarons et al., 2017; Williams et al., 2024 ).”
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Guerrero, E. G., & Khachikian, T. (2020) · IntechOpen eBooks · doi:10.5772/intechopen.91055 · Cited by 2
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“Additionally, several implementation strategies have been developed that specifically focus on leadership [12–14].”
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“20 The goal of this manuscript is to describe one of the flagship LDPs within the TTC network: the New England Addiction TTC’s LDP, which was first launched in 2004.”
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“Based on our fi nding that leadership behaviors are relevant to training adherence, a potentially relevant tool is the leadership and organizational change for implementation (LOCI; Aarons et al., 2015; Aarons et al., 2017; Skar et al., 2022).”
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“Leadership and Organizational Change for Implementation (LOCI [3], is an evidence-based implementation intervention that develops strategic implementation leadership and climate [1, 62, 72], ultimately improving teachers’ ICB [12].”
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MethodImplementation Science: Developing a Common Understanding for Use in Mental Health
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“It is this latter, cross-cutting conceptualisation that has led implementation researchers increasingly to treat leadership as a distinct object of study in its own right, rather than as one variable among many (Aarons et al., 2017).”
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Metadata
- Authors
- Aarons, G. A., Ehrhart, M. G., Moullin, J. C., Torres, E. M., & Green, A. E.
- Affiliations
- University of California San Diego (US)
- San Diego State University (US)
- Corresponding author
- Aarons, Gregory A.
- Venue
- Implementation Science
- Published
- 2017-03-03
- Volume
- 12
- Issue
- 1
- Pages
- 29-29
- ISSN
- 1748-5908 (ISSN-L)
- PMC
- PMC5335741
- OpenAlex
- W2592610820
- Cited by
- 159
- References
- 102
- Citations by year
- 2026: 8 · 2025: 17 · 2024: 25 · 2023: 18 · 2022: 19 · 2021: 28 · 2020: 19 · 2019: 15 · 2018: 9 · 2017: 1
- FWCI
- 19.50
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Implementation Science (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- eScholarship (California Digital Library) (submittedVersion, cc-by)
- eSpace (Curtin University) (submittedVersion, cc-by)
- Funders
- National Institute on Drug Abuse (R01DA038466)
- Topics
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Social Sciences › Business, Management and Accounting › Organizational Behavior and Human Resource Management › Organizational Change and Leadership
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Keywords
- implementation leadership, organizational change, evidence-based practice implementation, addiction treatment, motivational interviewing, leadership coaching, 360-degree assessment, implementation climate, organizational climate, employee attitudes, organizational support
- MeSH terms
- Attitude of Health Personnel, Diffusion of Innovation, Female, Health Personnel, Humans, Inservice Training, Leadership, Male, Motivation, Organizational Innovation, Substance-Related Disorders, Evidence-Based Practice
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Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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