Mark G. Ehrhart

• Ph.D.
• Professor (Full) at University of Central Florida

Objective: Little is known about how to sustain evidence-based interventions with fidelity in community mental health settings. Phase 1 of the Working to Implement and Sustain Digital Outcome Measures (WISDOM) trial showed that an organizational strategy improved the implementation of measurement-based care (MBC) in mental health services for yout...

Background Implementation of evidence-based practices (EBPs) in schools is fraught with challenges. Even when EBPs are initiated, deterioration of implementation efforts often hinders their long-term success. School leadership behaviors can influence teachers’ EBP implementation. Our study tested an implementation strategy called Helping Educationa...

The effectiveness of school-based universal prevention programs is frequently diminished due to low-quality implementation. Organizational factors support high-quality implementation because of their broad influence across implementers. Conceptually, implementation leadership (i.e., behaviors that prioritize, reward, and support evidence-based prac...

This study aimed to explore the reciprocal relationships between implementation leadership and practitioner implementation citizenship behavior during the implementation of evidence-based practices (EBPs). Data were collected at two timepoints with a time lag of six months during a national implementation of evidence-based treatment for post-trauma...

Background: Employee behaviors that strategically support implementation (i.e., implementation citizenship behavior) are hypothesized to promote the successful adoption and high-fidelity use of evidence-based practices (EBPs). Implementation citizenship behaviors may vary across contexts, including schools where children and youth are most likely t...

Background Integrated care involves care provided by a team of professionals, often in non-traditional settings. A common example worldwide is integrated school-based mental health (SBMH), which involves externally employed clinicians providing care at schools. Integrated mental healthcare can improve the accessibility and efficiency of evidence-ba...

Background Few “intervention agnostic” strategies have been developed that can be applied to the broad array of evidence-based practices (EBPs) in schools. This paper describes two studies that reflect the initial iterative redesign phases of an effective leadership-focused implementation strategy—Leadership and Organizational Change for Implementa...

Background Theory and correlational research indicate organizational leadership and climate are important for successful implementation of evidence-based practices (EBPs) in healthcare settings; however, experimental evidence is lacking. We addressed this gap using data from the WISDOM (Working to Implement and Sustain Digital Outcome Measures) hyb...

Background Although studies have demonstrated that implementation leadership and climate are important constructs in predicting evidence-based practice (EBP) implementation, concrete descriptions of how they operate during organizational implementation efforts are lacking. This case study fills that gap through an in-depth description of an organiz...

Although there are a growing number of implementation strategies to increase the adoption, fidelity, and sustainment of evidence-based practices (EBP), they are often complex and bulky, which can interfere with their widespread application. To address these challenges, the Helping Educational Leaders Mobilize Evidence (HELM) strategy was created as...

Background: Integrated care involves care provided by a team of professionals, often in non-traditional settings. A common example worldwide is integrated school-based mental health (SBMH), which involves externally employed clinicians providing care at schools. Integrated mental healthcare can improve the accessibility and efficiency of evidence-b...

Background Although healthcare is delivered in inherently multilevel contexts, implementation science has no widely endorsed methodological standards defining the characteristics of rigorous, multilevel implementation research. We identify and describe eight characteristics of high-quality, multilevel implementation research to encourage discussion...

Successful implementation of school-wide interventions (i.e., delivered to all students by a wide array of school personnel) is key to promoting students’ academic achievement and psychosocial development. Yet, the implementation of school-wide interventions is complex and can be psychologically taxing for implementing personnel. If evidence-based...

Fifteen to 20 years is how long it takes for the billions of dollars of health-related research to translate into evidence-based policies and programs suitable for public use. Over the past two decades, an exciting science has emerged that seeks to narrow the gap between the discovery of new knowledge and its application in public health, mental he...

Background High-quality implementation is crucial for students to reap the benefits of school-based evidence-based practices (EBP). Despite data being routinely used to support EBP delivery to students, there is a dearth of data-driven decision-making related to school-wide implementation of universal EBPs like Multi-Tiered Systems of Support (MTSS...

Organizational implementation climate is an important construct in implementation research to describe to what extent implementation is expected, supported, and rewarded. Efforts in bridging the research-practice gap by implementing evidence-based practice (EBP) can benefit from consideration of implementation climate. The Implementation Climate Sc...

Background The literature on perceptual differences between managers and staff regarding social dynamic factors (e.g., leadership, climate) in nursing settings is sparse. Addressing this gap in knowledge is critical for informing implementation efforts and improving patient and organizational outcomes. The purpose of this study was to test the perc...

Background The Evidence-Based Practice Attitudes Scale (EBPAS) is widely used in implementation research, but it has not been adapted and validated for use among general education teachers, who are most likely to deliver evidence-based prevention programs in schools, the most common setting where youth access social, emotional, and behavioral healt...

Emerging literature has highlighted the importance of discerning general and strategic organizational context (OC) factors (e.g., leadership and climate) and their interaction effect on individual implementation behaviors (e.g., attitudes toward evidence-based practices; EBPs) in youth mental healthcare. This study aimed to examine how leadership a...

The Leadership and Organizational Change for Implementation (LOCI) strategy is a multifaceted implementation strategy that aims to support successful evidence-based practice (EBP) implementation by fostering effective general leadership, implementation leadership, and implementation climate. How implementation strategies are experienced by particip...

Background Implementation climate is an organizational construct theorized to facilitate the adoption and delivery of evidence-based practices. Within schools, teachers often are tasked with implementing universal prevention programs. Therefore, they are ideal informants when assessing school implementation climate for initial and continuous implem...

Background: Strategic implementation leadership is a critical determinant of successful implementation, hypothesized to create a more supportive implementation climate conducive to the adoption and use of evidence-based practices. Implementation leadership behaviors may vary significantly across contexts, necessitating studies that examine the vali...

For Schoolwide Positive Behavior Interventions and Supports (SWPBIS) to be effective, educators must use the practices as intended. Whether a teacher uses a practice as intended can depend, in part, on how feasible the practice is perceived to be. Identifying malleable factors associated with teachers’ perceptions of SWPBIS feasibility can help sch...

Emerging literature highlighted the importance to discern the general and strategic types of organizational context (OC) factors (e.g., leadership and climate) and explore their interaction effect on individual implementation behaviors (e.g., attitudes toward evidence-based practices; EBPs) in youth mental healthcare. This study aimed to examine th...

Background The education sector is one of the most common and accessible settings for universal prevention programs for youth mental health. But it suffers from suboptimal implementation of evidence-based practices (EBPs). Although the organizational context (OC) contains crucial implementation factors, successful implementation ultimately resides...

Background This study evaluates the Leadership and Organizational Change for Implementation (LOCI) strategy and its effect on implementation leadership, transformational leadership, and implementation climate. Methods A stepped wedge cluster randomized study design enrolling 47 first-level leaders from child- and adult-specialized mental health cl...

Background Strategic implementation leadership is a critical determinant of successful implementation, hypothesized to create a more supportive implementation climate conducive to the adoption and use of evidence-based practices. Implementation leadership behaviors may vary significantly across contexts, necessitating studies that examine the valid...

Funding is a major barrier to implementation of evidence-based practices (EBPs) in publicly-funded community mental health clinics (CMHCs). Understanding how best to deploy implementation strategies that address this barrier requires greater clarity on the financial context within agencies. We developed the Agency Financial Status Scales (AFSS) to...

Background Implementation scientists and practitioners often rely on frontline providers for reporting on implementation outcomes. Furthermore, measures of sustainment are few, and available sustainment measures are mainly setting or evidenced-based practice (EBP) specific, require organizational and system-level knowledge to complete, and often la...

Background: This study evaluates the Leadership and Organizational Change for Implementation (LOCI) strategy and its effect on implementation leadership, transformational leadership, and implementation climate. Methods: A stepped wedge cluster randomized trial enrolled 47 first-level leaders from child- and adult-specialized mental health clinics w...

Background: Organizational culture, organizational climate, and implementation climate are key organizational constructs that influence the implementation of evidence-based practices. However, there has been little systematic investigation of the availability of psychometrically strong measures that can be used to assess these constructs in behavi...

Objective: The novel coronavirus disease (COVID-19) has drastically impacted the provision of mental health services. Changes required of providers were substantial and could lead to increased burnout and, subsequently, increased turnover intentions. This study examined burnout experienced by mental health services providers in the context of COVID...

Aim: This study aimed to evaluate the validity, reliability and acceptability of the Implementation Leadership Scale in the Chinese nursing context. Design: This study utilized a cross-sectional design. Methods: This study was conducted in one general tertiary hospital with 234 nurses (85.3% response rate) from 35 clinical units in China. Cont...

Background: The successful implementation of evidence-based practices (EBPs) in real-world settings requires an adaptive approach and ongoing process evaluation and tailoring. Although conducting a needs assessment during the preparation phase of implementation is beneficial, it is challenging to predict all barriers to EBP implementation that may...

Background: One critical factor in effective implementation of evidence-based practices (EBPs) in nursing is an organizational context that facilitates and supports implementation efforts. Measuring implementation climate can add useful insights on the extent to which the organizational context supports EBP implementation. Aims: This study cross...

Background The COVID-19 pandemic has remarkably altered community mental health service delivery through the rapid implementation of telehealth. This study reports provider perspectives on the impact that COVID-19 and the transition to telehealth had on their work and their ability to deliver evidence-based practices (EBPs). Methods Providers ( n...

Purpose Clinician turnover in mental health settings impacts service quality, including availability and delivery of evidence-based practices. Leadership is associated with organizational climate, team functioning and clinician turnover intentions (TI). This study examines leader–member exchange (LMX), reflecting the relationship between a supervis...

The study of organizational climate has had a long history that in many ways mirrors the development of the fields of organizational psychology and organizational behavior, and demonstrates the critical role of the environment in individual and organizational effectiveness. High levels of interest in organizational climate, largely coming from rese...

Background: The COVID-19 pandemic has swiftly and remarkably altered community mental health service delivery and evidence-based practice (EBP) implementation. This study reports provider perspectives on the impact that COVID-19 had on their work and EBP implementation. Methods: Providers (n = 93) completed online surveys with quantitative measures...

The organizational context in which substance use disorder treatment (SUDT) evidence-based practices (EBPs) are implemented plays a critical role in successful implementation. Employee behaviors that go above and beyond typical job requirements to support EBP implementation have been suggested to facilitate the likelihood of overall implementation...

Background: One critical factor in the implementation of evidence-based practice (EBP) in substance use disorder treatment organizations is an inner organizational context that clearly supports implementation efforts. The Implementation Climate Scale (ICS) has been developed to allow researchers and organizations to assess climate for EBP implemen...

Objective: International collaboration in science has received increasing attention given emphases on relevance, generalizability, and impact of research. Implementation science (IS) is a growing discipline that aims to translate clinical research findings into health services. Research is needed to identify efficient and effective ways to foster...

Background: Frontline nurse managers influence the implementation of evidence-based practices (EBP); however, there is a need for valid and reliable instruments to measure their leadership behaviors for EBP implementation in acute care settings. Aim: The aim of this study was to evaluate the validity and reliability of the Implementation Leaders...

Key features of the school environment can have a significant impact on teachers’ effective use of evidence-based practices (EBP), yet implementation-specific organizational constructs have rarely been studied in the education sector. This study examined three aspects of the organizational implementation context (implementation leadership, climate,...

Studies demonstrate that discrepancies among leader–follower perceptions of leadership are related to organizational processes that may impact evidence-based practice (EBP) implementation. However, it is unknown whether discrepancies in leadership perceptions also predict EBP use. This study examined the association of principal–staff alignment and...

Background: Alignment across levels of leadership within an organization is needed for successful implementation of evidence-based practice. The leadership and organizational change for implementation (LOCI) intervention is a multi-faceted multilevel implementation strategy focusing on enhancing first-level general and implementation leadership wh...

Aim To translate the Implementation Leadership Scale (ILS) into Chinese and evaluate how Chinese nursing staff and leaders understood and responded to the Chinese ILS. Background Leadership is a critical factor for implementing evidence‐based practice. The ILS is a valid and reliable instrument to understand leadership for evidence‐based practice;...

Recent literature has focused on identifying factors that facilitate or impede the implementation of innovation in organizations. Attitudes toward change and transformational leadership are regarded as important determinants of implementation success. This study tested a multilevel model of transformational leadership and leaders’ attitudes toward...

Background: The Evidence-Based Practice Attitude Scale (EBPAS) is a widely used tool, but it has not been adapted and validated for use in schools, the most common setting where youth access behavioral health services. This study examined the factor structure, psychometric properties, and criterion-related validity of the school-adapted EBPAS in a...

The managers of community-based organizations that are contracted to deliver publicly funded programs, such as in the child welfare sector, occupy a crucial role in the implementation and sustainment of evidence-based interventions to improve the effectiveness of services, as they exert influence across levels of stakeholders in multitiered systems...

Background: Implementation is proposed to be a multiphase, multilevel process. After a period of exploration, an adoption decision is made, typically at the upper management or policy level. Nevertheless, movement through each of the subsequent phases of the implementation process involves clinicians or providers at the individual level to adopt t...

Background: Behavioral health organizations are characterized by multiple organizational climates, including molar climate, which encompasses clinicians' shared perceptions of how the work environment impacts their personal well-being, and strategic implementation climate, which includes clinicians' shared perceptions of the extent to which eviden...

Background: Integrated healthcare delivered by work groups in nontraditional service settings is increasingly common, yet contemporary implementation frameworks typically assume a single organization-or organizational unit-within which system-level processes influence service quality and implementation success. Recent implementation frameworks pre...

Background Despite our progress in understanding the organizational context for implementation and specifically the role of leadership in implementation, its role in sustainment has received little attention. This paper took a mixed-method approach to examine leadership during the sustainment phase of the Exploration, Preparation, Implementation, S...

Background: A substantial literature has established the role of the inner organizational setting on the implementation of evidence-based practices in community contexts, but very little of this research has been extended to the education sector, one of the most common settings for the delivery of mental and behavioral health services to children...

Implementation is posited as a multiphasic process, influenced by a range of factors, within a multilevel context. While there appears to be a general consensus that every implementation initiative will have a unique combination of influences that vary in importance across the implementation phases, leadership is an essential tenant throughout impl...

Purpose Leadership in health care is instrumental to creating a supportive organizational environment and positive staff attitudes for implementing evidence-based practices to improve patient care and outcomes. The purpose of this study is to demonstrate the alignment of the Ottawa Model of Implementation Leadership (O-MILe), a theoretical model fo...

Background Evidence-based practice (EBP) implementation represents a strategic change in organizations that requires effective leadership and alignment of leadership and organizational support across organizational levels. As such, there is a need for combining leadership development with organizational strategies to support organizational climate...

Although often discussed, there is a lack of empirical research on the role of leadership in the management and delivery of health services. The implementation leadership scale (ILS) assesses the degree to which leaders are knowledgeable, proactive, perseverant, and supportive during evidence-based practice (EBP) implementation. The purpose of this...

Objectives: Discrepancies, or perceptual distance, between leaders' self-ratings and followers' ratings of the leader are common but usually go unrecognized. Research on discrepancies is limited, but there is evidence that discrepancies are associated with organizational context. This study examined the association of leader-follower discrepancies...

Both organizational characteristics and specific organizational strategies are important for the effective dissemination and implementation of evidence-based practices (EBPs) in health and allied health care settings, as well as mental health, alcohol/drug treatment, and social service settings. One of the primary goals of this chapter is to suppor...

Research on the internal psychosocial environment of work organizations has largely been captured through the study of two constructs: organizational climate and organizational culture. Despite the inherent similarities between the two constructs, they have largely been studied in separate literatures, by different sets of researchers, and more oft...

Purpose There is growing research evidence that workplace factors influence disability outcomes, but these variables reflect a variety of stakeholder perspectives, measurement tools, and methodologies. The goal of this article is to summarize existing research of workplace factors in relation to disability, compare this with employer discourse in t...

Purpose For work disability research to have an impact on employer policies and practices it is important for such research to acknowledge and incorporate relevant aspects of the workplace. The goal of this article is to summarize recent theoretical and methodological advances in the field of Implementation Science, relate these to research of empl...

If evidence-based interventions (EBIs) are not sustained, investments are wasted and public health impact is limited. Leadership has been suggested as a key determinant of implementation and sustainment; however, little empirical work has examined this factor. This mixed-methods study framed using the Exploration, Preparation, Implementation, Susta...

Sustainment of evidence-based interventions (EBIs) in human services depends on the inner context of community-based organizations (CBOs) that provide services and the outer context of their broader environment. Increasingly, public officials are experimenting with contracting models from for-profit industries to procure human services. In this cas...

There have been recent calls for pragmatic measures to assess factors that influence evidence-based practice (EBP) implementation processes and outcomes. The Implementation Leadership Scale (ILS) is a brief and efficient measure that can be used for research or organizational development purposes to assess leader behaviors and actions that actively...

The Implementation Leadership Scale (ILS) is a brief, pragmatic, and efficient measure that can be used for research or organizational development to assess leader behaviors and actions that actively support effective implementation of evidence-based practices (EBPs). The ILS was originally validated with mental health clinicians. This study valida...

Organizational climate research represents one of the primary approaches to understanding work environment in organizations. Employee perceptions of organizational climate affect nearly all aspects of organizational life including employee attitudes and behavior, group processes, and organizational performance. Research on organizational climate ga...

Background: We examine the perspectives of upper-level management to identify, describe, and assess both opportunities and challenges affecting the ability of community-based organization (CBOs) to cultivate and maintain local capacity to implement an evidence-based intervention (EBI) to reduce and prevent child maltreatment in 11 service systems s...

Child neglect is the most prevalent form of child maltreatment and represents 79.5% of open child-welfare cases. A recent study found the evidence-based intervention (EBI) SafeCare(®) (SC) to significantly reduce child neglect recidivism rates. To fully capitalize on the effectiveness of such EBIs, service systems must engage in successful implemen...

There is increasing emphasis on the use of evidence-based practices (EBPs) in child welfare settings and growing recognition of the importance of the organizational environment, and the organization's climate in particular, for how employees perceive and support EBP implementation. Recently, Ehrhart, Aarons, and Farahnak (2014) reported on the deve...

This study addresses how job seekers' experiences of rude and discourteous treatment-incivility-can adversely affect self-regulatory processes underlying job searching. Using the social-cognitive model (Zimmerman, 2000), we integrate social-cognitive theory with the goal orientation literature to examine how job search self-efficacy mediates the re...

In healthcare and allied healthcare settings, leadership that supports effective implementation of evidenced-based practices is critical. There is only one empirically validated measure to assess implementation leadership, the Implementation Leadership Scale (ILS). This study moves beyond testing the ILS with clinicians to assess the factor structu...

The role of leadership in the management and delivery of health and allied health services is often discussed but lacks empirical research. Discrepancies are often found between leaders' self-ratings and followers' ratings of the leader. To our knowledge no research has examined leader-follower discrepancies and their association with organizationa...

In line with recent research on the role of the inner context of organizations in implementation effectiveness, this study extends research on organizational citizenship behavior (OCB) to the domain of evidence-based practice (EBP) implementation. OCB encompasses those behaviors that go beyond what is required for a given job that contribute to gre...

Organizational climate refers to employees' shared perceptions of the policies, practices and procedures and the behaviors that get rewarded, supported, and expected in a work setting. As a distinct construct from individual work attitudes like job satisfaction, climate exists at the group or organization level of analysis, and captures the human e...

Leadership is important in the implementation of innovation in business, health, and allied health care settings. Yet there is a need for empirically validated organizational interventions for coordinated leadership and organizational development strategies to facilitate effective evidence-based practice (EBP) implementation. This paper describes t...

Background: This study examines sustainment of an EBI implemented in 11 United States service systems across two states, and delivered in 87 counties. The aims are to 1) determine the impact of state and county policies and contracting on EBI provision and sustainment; 2) investigate the role of public, private, and academic relationships and coll...

Background Although the importance of the organizational environment for implementing evidence-based practices (EBP) has been widely recognized, there are limited options for measuring implementation climate in public sector health settings. The goal of this research was to develop and test a measure of EBP implementation climate that would both ca...

In healthcare and allied healthcare settings, leadership that supports effective implementation of evidenced-based practices (EBPs) is a critical concern. However, there are no empirically validated measures to assess implementation leadership. This paper describes the development, factor structure, and initial reliability and convergent and discri...

There has been a growing impetus to bridge the gap between basic science discovery, development of evidence-based practices (EBPs), and the availability and delivery of EBPs in order to improve the public health impact of such practices. To capitalize on factors that support implementation and sustainment of EBPs, it is important to consider that h...

The fields of organizational climate and organizational culture have co-existed for several decades with very little integration between the two. In Organizational Climate and Culture: An Introduction to Theory, Research, and Practice, Mark G. Ehrhart, Benjamin Schneider, and William H. Macey break down the barriers between these fields to encourag...