Mechanisms of Change in the ARC Organizational Strategy: Increasing Mental Health Clinicians’ EBP Adoption Through Improved Organizational Culture and Capacity

  • Nathaniel J. WilliamsEmail author
  • Charles Glisson
  • Anthony Hemmelgarn
  • Philip Green
Original Article


The development of efficient and scalable implementation strategies in mental health is restricted by poor understanding of the change mechanisms that increase clinicians’ evidence-based practice (EBP) adoption. This study tests the cross-level change mechanisms that link an empirically-supported organizational strategy for supporting implementation (labeled ARC for Availability, Responsiveness, and Continuity) to mental health clinicians’ EBP adoption and use. Four hundred seventy-five mental health clinicians in 14 children’s mental health agencies were randomly assigned to the ARC intervention or a control condition. Measures of organizational culture, clinicians’ intentions to adopt EBPs, and job-related EBP barriers were collected before, during, and upon completion of the three-year ARC intervention. EBP adoption and use were assessed at 12-month follow-up. Multilevel mediation analyses tested changes in organizational culture, clinicians’ intentions to adopt EBPs, and job-related EBP barriers as linking mechanisms explaining the effects of ARC on clinicians’ EBP adoption and use. ARC increased clinicians’ EBP adoption (OR = 3.19, p = .003) and use (81 vs. 56 %, d = .79, p = .003) at 12-month follow-up. These effects were mediated by improvement in organizational proficiency culture leading to increased clinician intentions to adopt EBPs and by reduced job-related EBP barriers. A combined mediation analysis indicated the organizational culture-EBP intentions mechanism was the primary carrier of ARC’s effects on clinicians’ EBP adoption and use. ARC increases clinicians’ EBP adoption and use by creating proficient organizational cultures that increase clinicians’ intentions to adopt EBPs.


Mechanism Mediation Organizational implementation strategy Organizational culture Intervention Mental health Evidence-based practice ARC 



This study was funded by grants from the National Institute of Mental Health to NJW (F31MH099846) and CG (R01MH084855). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Mental Health.

Compliance with Ethical Standards

Conflict of interest

Nathaniel Williams declares that he has no conflict of interest. Charles Glisson declares that he has no conflict of interest. Anthony Hemmelgarn declares that he has no conflict of interest. Philip Green declares that he has no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Nathaniel J. Williams
    • 1
    Email author
  • Charles Glisson
    • 2
  • Anthony Hemmelgarn
    • 2
  • Philip Green
    • 2
  1. 1.School of Social WorkBoise State UniversityBoiseUSA
  2. 2.Children’s Mental Health Services Research CenterUniversity of TennesseeKnoxvilleUSA

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