Organizational Change – Technology Transfer Processes: A Review of the Literature

Abstract

Over the last two decades, researchers from various disciplines have developed models for examining how to best import innovations in organizations. Such technology transfer (TT) models provide a conceptual framework for identifying and measuring the key components of the innovation diffusion process. In this chapter, the emphasis is on studies that have assessed the models and/or factors that affect the success of TT models in criminal justice and substance abuse treatment agencies as well as other human and social service agencies. Each model emphasizes slightly different components, but together they represent pathways for organizations to contemplate. Lessons from these conceptual frameworks are the building blocks for a new conceptual model that will expedite and facilitate the transfer of evidence to practice in dynamic settings that are characterized by multilayered processes involving an organization and the systems in which they thrive.

Appendix

4.1.1 Summary of Major Findings from Organizational Studies in Behavioral Health Examining Inner Setting Issues

	Study author(s)	Major finding(s)
Staff training	Aarons, Sommerfeld, Hecht, Silovsky, and Chaffin (2009)	Adoption of SafeCare (EBP) and fidelity monitoring associated with less staff turnover
	Aarons, Wells, Zagursky, Fettes, and Palinkas (2009)	Staff development and support were important as a barrier to EBP adoption, but changeable
	Knudsen et al., (2005)a	Receiving buprenorphine-specific training was associated with increased likelihood of buprenorphine diffusion, whereas counselors who received specialized training in buprenorphine were more likely to perceive buprenorphine as effective and acceptable
	Knudsen and Roman (2004)	More licensed staff was associated with more environmental scanning
Staff attitudes	Roman et al., (2010)	Medical staff preferred not to use buprenorphine
	Aarons, Fettes, Flores, and Sommerfeld (2009)	Adoption of SafeCare (EBP) associated with lower emotional exhaustion
Knowledge of staff	Knudsen et al., (2005)a	Greater use of the NIDA website was associated with increased likelihood of buprenorphine diffusion
Leadership	Roman and Johnson (2002)a	Programs with more tenured administrators in the treatment field were more likely to adopt naltrexone, but an administrator with a medical degree made implementation with alcohol-dependent patients more likely. Administrators with a business degree made implementation of naltrexone with opiate-dependent patients more likely
	Roman et al., (2006)b	Having an administrator with a medical background increased the likelihood of adopting pharmacotherapies
Management style	Aarons (2006)	Transactional leaders increased openness to adopting EBPs, while transformational leaders were associated with increased willingness to adopt if required and decreased perceptions of divergence from current practice
Treatment philosophy	Roman et al., (2010)c	Inconsistency of the practice with treatment philosophies prevented adoption of both buprenorphine and MI/CM
	Aarons, Wells, et al., (2009)	Clinical perceptions were important barriers to EBP adoption, but changeable
	Knudsen et al., (2005)a	Endorsing 12-step programming was associated with lower perceptions of buprenorphine as acceptable
Structure	Aarons (2004, 2005)	Treatment programs with less bureaucracy and more formalization appear to have more positive attitudes toward EBP adoption, whereas attitudes toward adoption vary by program type
	Aarons (2004)	Case management programs had a lower appeal toward adoption of EBP as compared to outpatient programs, while wraparound programs were more open; day treatment programs had more positive attitudes when required to adopt
	Abraham, Knudsen, Rothrauff, and Roman (2010)c	Government-owned programs were more likely to use tablet naltrexone at follow-up
	Ducharme et al., (2007)c	Programs with detoxification services were more likely to adopt buprenorphine, while programs with primary funding from government grants and contracts, nonprofit, not accredited, and not outpatient-only programs were more likely to adopt voucher-based motivational incentives
	Roman and Johnson (2002)a	Treatment centers operating longer were more likely to adopt naltrexone and implement the medication with opiate-dependent patients
	Knudsen, Abraham, Johnson, and Roman (2009)c	Programs which are private funded, larger, operate inpatient detoxification, and use methadone maintenance were associated with early adoption of buprenorphine; however being a for-profit program and having inpatient detoxification services were associated with adoption at the 24-month follow-up
	Knudsen et al., (2006)a	Programs which are private, accredited, use detoxification services, and use naltrexone were more likely to adopt buprenorphine early and at follow-up, while larger centers, and those using mixed inpatient and outpatient care were more likely to be early adopters and for-profit were more likely to be adopters at follow-up
	Knudsen et al., (2005)a	Working in a treatment center that had adopted buprenorphine was associated with increased likelihood of buprenorphine diffusion and counselor perception of buprenorphine effectiveness and acceptability, while being surveyed post-FDA approval was associated with increased likelihood of buprenorphine diffusion
	Knudsen, and Roman (2004)	For-profit, hospital-based, and larger centers are more likely to use treatment innovations and collect satisfaction data
	Roman et al., (2006)b	Both public and private centers that are accredited provide detoxification services, and use of naltrexone was associated with the use of buprenorphine, while for-profit, private, and larger centers were more likely to adopt SSRIs
Staff experience	Aarons (2004, 2005, 2006); Aarons and Sawitzky (2006)	More experienced staff appear to view EBP adoption as less appealing and more divergent from current practice, and are less open to adoption than interns
	Aarons (2004, 2005, 2006); Aarons and Sawitzky (2006)	Those with a higher education had improved attitudes toward adoption of EBPs
	Abraham et al., (2010)c; Roman and Johnson (2002)a	Programs with more counselors with master’s degrees were more likely to adopt acamprosate in 2006, as well as adopt naltrexone
	Knudsen et al., (2005)a	Counselors in recovery and with more experience were associated with increased likelihood of buprenorphine diffusion
	Knudsen et al., (2005)a	Holding a master’s degree was associated with an increased likelihood of perceiving buprenorphine as effective
	Knudsen and Roman (2004)	Treatment centers with more master’s degree level counselors use more treatment innovations and collect satisfaction data, and more counselors in recovery were associated with more collection of satisfaction data
Culture and climate	Aarons and Sawitzky (2006)	A more constructive culture was associated with increased attitudes, openness, and overall perceptions of EBP adoption; whereas a negative climate was associated with greater perceived divergence from current practice
	Bride, Abraham, and Roman (2011)a	More supportive, nonconfrontational programs and that had prior research experience were more likely to use contingency management
	Aarons, Sommerfeld, et al., (2009)	Increased perceptions of job autonomy were associated with decreased risk of turnover
Caseload characteristics	Aarons, Fettes, et al., (2009)	Increased caseload was associated with increased emotional exhaustion
	Bride et al., (2011)a	Programs with outpatient, drug-court, or adolescent patients were more likely to use contingency management
	Ducharme et al., (2007)c; Knudsen et al., (2006)a	Programs with increased opiate dependent clients were more likely to use buprenorphine
	Roman and Johnson (2002)a	Programs with more patients covered by HMOs, PPOs, or managed care, or who have previously relapsed are more likely to adopt naltrexone, while more referral sources are more likely to implement to more alcohol-dependent patients
	Roman et al., (2006)b	As the number of opiate-dependent clients increase for both private and public centers, than so does the use of buprenorphine
Other organizational factors
Interorganizational interactions	Roman et al., (2010)c	The CTN’s community treatment programs (CTP) reported a high-quality relationship with the Regional Research and Training Center as well as improved communication with other CTPs about new substance abuse treatment techniques
	Abraham et al., (2010)c	Programs participating in CTN were more likely to adopt and use acamprosate in 2006 and tablet naltrexone at follow-up than non-CTN programs
	Ducharme et al., (2007)c	CTN programs exposed to clinical trials with buprenorphine were more likely to use the medication for treatment
	Knudsen et al., (2009)c	CTN programs involved in buprenorphine protocols were more likely to adopt early and at 24-month follow-up
	Knudsen et al., (2007)c	Staff who experienced increased perceptions of organizational benefits from participation in CTN trials were associated with fewer intentions to leave the job, while increased perceptions of stress from participation were associated with increased intentions to leave
	Knudsen and Roman (2004)	Treatment centers with more environmental scanning (external knowledge collection) and collection of satisfaction data use more treatment innovations
Available resources and costs	Roman et al., (2010)c	Cost, access to the necessary personnel, regulatory barriers, and liability concerns were barriers to buprenorphine adoption, whereas cost, logistics, and perceived ineffectiveness blocked MI/CM adoption
	Aarons, Wells, et al., (2009)	Funding rated as most important and least changeable barrier to EBP adoption, followed by staff resources, and research; outcomes supporting the EBP being important but changeable
	Abraham et al., (2010)c	Programs with access to a physician were more likely to adopt acamprosate in 2006 and tablet naltrexone at baseline, as well as being more likely to use buprenorphine
	Ducharme et al., (2007)c
	Knudsen et al., (2006, 2009)a, c	Programs with access to physicians were more likely to be an early adopter of buprenorphine
	Knudsen and Roman (2004)	Having a physician on staff was associated with more environmental scanning
	Roman et al., (2006)b	As the number of staff physicians increases so does the use of buprenorphine and SSRIs, and increased number of legal system referrals decreases use of SSRIs while increased number of workplace and employee assistance referrals increases use of SSRIs
Dissemination	Roman et al., (2010)c	Approximately 86% of participating community treatment programs took part in at least one dissemination activity of the Clinical Trial Network

^a Indicates National Treatment Center Study (NTCS)

^b Indicates both CTN and NTCS data

^c Indicates a Clinical Trial Network (CTN) study