Measuring Organizational Capacity for Integrated Treatment

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Behavioral health program leaders, practitioners, policy makers, and researchers have a keen interest in understanding how best to implement and sustain evidence-based practices. Among the most important determinants of successful implementation are organizational factors, such as an organization’s structure, climate, resources, and leadership. Yet despite the recognition that organizational characteristics matter, the field remains largely in a prescientific stage of development. For example, experienced leaders believe they know, by reputation, which are the most competent service agencies in their state or region, and further, which ones are most competent in implementing innovative practices. But how accurate are these beliefs? Are reputational ratings predictive of success in implementing a new program? Over a half-century ago, Meehl (1954) showed that clinical judgment was often useless in predicting client outcome. In nearly every study, actuarial calculation based on objective indicators was a better predictor of outcome than clinical prediction. Thus global clinical judgments, whether they be about predicting improvement in client outcomes or readiness of an organization to change are poorer guides to action than are objective scales measuring discrete aspects of performance. But the development and validation of scales requires hard work, and much has yet to be done at the organizational level in integrated treatment.