# Effects of a leadership-focused implementation strategy on uptake of digital measurement-based care in mental health clinics: a cluster randomized trial

## TL;DR

A leadership training program helped mental health clinics adopt digital tools for patient care more effectively over three years.

## Contribution

A leadership-focused implementation strategy improved uptake and sustainment of digital measurement-based care in mental health clinics.

## Key findings

- Clinics with LOCI training had higher initial uptake of digital MBC compared to standard training.
- The LOCI strategy showed sustained benefits in digital MBC adoption even after 35 months.
- Leadership training improved both measure administration and feedback viewing rates in clinics.

## Abstract

Leaders of healthcare organizations are often called on to guide the implementation of new innovations, including evidence-based practices and digital health technologies. However, many leaders lack preparation for this role and most available leadership trainings have not been rigorously tested, particularly over periods incorporating multiple implementation phases.

This study tested the effects of the Leadership and Organizational Change for Implementation (LOCI) strategy on the uptake of digital measurement-based care (MBC) in mental health settings across 35 months, incorporating implementation and sustainment phases.

In 21 outpatient mental health clinics serving youth, a two-arm, cluster randomized, hybrid type III effectiveness-implementation trial tested whether adding LOCI (k = 11) to standard digital MBC training and technical assistance (k = 10) improved uptake of digital MBC, assessed using system generated data and operationalized as clinic-level monthly counts of the number of youths with a measure administered and with feedback viewed by their clinician.

On both outcomes, clinics randomized to LOCI exhibited superior initial uptake (3 months post-baseline: mean difference in youths with measure administered per clinic (MYMA_Diff=5.09, 95% CI=[1.63–8.55]); mean difference in youths with feedback viewed per clinic (MYFV_Diff=3.81 [1.26–6.37]), superior uptake when the implementation phase concluded (13 months post-baseline: MYMA_Diff=9.03, [1.64–16.41]; MYFV_Diff=8.31 [3.07–13.56]), and superior uptake when the sustainment phase concluded (35 months post-baseline: MYMA_Diff=3.82 [1.28–6.36]; MYFV_Diff=1.41 [0.22–2.60]).

LOCI is an effective approach for training organizational leaders to support implementation of evidence-based digital health technologies in healthcare settings. Studies examining how policy-level variables interact with leadership training are needed.

Adding a leadership-focused strategy to standard training and technical assistance significantly improved the implementation and sustainment of a new health technology over nearly three years.