Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA.
Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA.
Adm Policy Ment Health. 2023 Jul;50(4):673-684. doi: 10.1007/s10488-023-01269-8. Epub 2023 May 5.
Therapist self-efficacy in delivering evidence-based practices (EBPs) is associated with implementation outcomes, including adoption and sustainment in community mental health settings. Inner context organizational climate, including psychological safety, can proximally shape therapist learning experiences within EBP implementation. Psychologically safe environments are conducive to learning behaviors including taking risks, admitting mistakes, and seeking feedback. Organization leaders are instrumental in facilitating psychological safety, but may have differing perspectives of organizational climate than front-line therapists. Discrepant leader and therapist views of psychological safety may have independent associations with therapist EBP learning and implementation outcomes over and above average therapist perceptions of climate. This study examined survey data from 337 therapists and 123 leaders from 49 programs contracted to deliver multiple EBPs within a study examining determinants of sustainment within a large system-driven implementation. Both leaders and therapists completed measures of psychological safety climate and therapists reported on their self-efficacy in delivering multiple EBPs in children's mental health services. Polynomial regression and response surface analysis models were conducted to examine the associations of therapist and leader reports of psychological safety and therapist EBP self-efficacy. Greater discrepancies between leader and therapist reports of psychological safety, in either direction, were associated with lower therapist EBP self-efficacy. Alignment in leader and therapist views of psychological safety climate may impact EBP implementation outcomes. Strategies for improving alignment in perceptions and priorities among organizational members can be included in organizational implementation interventions and may represent unexamined implementation mechanisms of action.
治疗师在提供循证实践 (EBP) 方面的自我效能感与实施结果相关，包括在社区心理健康环境中的采用和维持。内部环境组织氛围，包括心理安全，可以在 EBP 实施过程中直接影响治疗师的学习体验。心理安全的环境有利于学习行为，包括承担风险、承认错误和寻求反馈。组织领导者在促进心理安全方面起着重要作用，但他们对组织氛围的看法可能与一线治疗师不同。领导者和治疗师对心理安全的不同看法可能与治疗师的 EBP 学习和实施结果独立相关，而不仅仅是治疗师对气候的平均看法。本研究调查了来自 49 个项目的 337 名治疗师和 123 名领导者的调查数据，这些项目受雇于一项研究，该研究旨在检查在一个由系统驱动的大型实施中维持的决定因素。领导者和治疗师都完成了心理安全氛围的测量，治疗师报告了他们在儿童心理健康服务中提供多种 EBP 的自我效能感。进行了多项式回归和响应面分析模型，以检查治疗师和领导者报告的心理安全和治疗师 EBP 自我效能感之间的关联。领导者和治疗师对心理安全的报告之间存在更大的差异，无论是在哪个方向，都与治疗师的 EBP 自我效能感较低相关。领导者和治疗师对心理安全氛围的看法的一致性可能会影响 EBP 实施结果。在组织成员中提高看法和优先事项一致性的策略可以包括在组织实施干预措施中，并且可能代表未被检查的实施行动机制。
