Staff perceptions and attitudes; does organizational leadership matter in adolescent residential care?

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1 Staff perceptions and attitudes; does organizational leadership matter in adolescent residential care? MultiFunC Implementation study Carl I Holmen 1, 3, Shery Namvar 1, 2 Bjørn Helge Handegård 1 and Sturla Fossum 1 1 RKBU University of Tromsø 2 Telemedicine, Tromsø Aim of study To examine whether organizational leadership, staff attitudes and performance co-varied over time in the context of organizational change in treatment delivery centers The setting was 6 residential care centers implementing the MultifunC treatment model for adolescents with severe behavioral and drug problems 2 1

2 Telemedicine, Tromsø Aim of study To examine whether organizational leadership, staff attitudes and performance co-varied over time in the context

2 MultifunC The treatment model Background Norwegian expert conference in 1997 identified need for new treatment methodology & research A need for an effective inpatient (residential care program) for adolescents with severe behavioral and drug problems who respond inadequately to outpatient treatments such as MST Residential care programs traditionally struggle with violence, drug abuse, insufficient training and lack of structured treatment programs for youth residents. More importantly perhaps, iatrogenic effects and recidivism among the treatment population are well documented 3 MultifunC The treatment model Developed on the basis of international research on institutional treatment of adolescent serious drug and behavioral problems. The model consists of a short residential treatment period followed by an integrated after care period where the adolescent is reintroduced into the community. Typical length of treatment is 12 months, including 6-8 month aftercare A critical component is family involvement. Quality assurance team provides overall and case-specific supervision Goals: improve school functioning/ day-time activities stop conduct problems, drug use and improve pro-social skills Change not only adolescents behavior but parents and immediate network establish contact with organizations and people who can contribute to continued positive development after the completion of residential treatment 4 2

insufficient training and lack of structured treatment programs for youth residents.

3 Respondents The participants: All staff members in 6 MultifunC institutions invited to participate. The institutions are located in five health regions in Norway, South, East, West, Middle and North. The recipients were asked to fill out a questionnaire six times at each institution. A total of 462 questionnaires were answered across T1-T6. 5 Respondents - table 1 Table 1. Demographic information of the staff at T1* Ins 1* Ins 2* Ins 3 Ins 4 Ins 5 Ins 6 Employment fulltime (%) Number of months experience Men n (%) 9 (64.3) 2 (40) 11 (47.8) 3(30) 1 3(30) Women n (%) 5 (35.7) 3 (60) 12 (52.2) 7(70) 5 7(70) Received training at t Note. *when no data available from t1, t2 reported 6 3

A total of 462 questionnaires were answered across T1-T6. 5 Respondents - table 1 Table 1.

4 Method To evaluate staff perceptions of the implementation of MultifunC, program developer and researchers jointly developed a questionnaire (Carplan, Hultman, Andreassen, & Fossum, 2006b). The questionnaire consists of 14 domains with sub-domains. Staff was asked to fill out a five-point likert scale, 1= inadequate, 2=less than adequate, 3=adequate, 4= Good and 9=not applicable. Questionnaires were distributed by post to upper management at the institutions and the staff were invited to answer them anonymously by returning it to the principal investigator at each time points (T1 through T6) over a three-year period. 7 Method The analyses were done with 4 composite scores. Composite score 1 named Organizational Leadership comprised of the mean score from 8 items tapping staff perceptions of leadership, scores ranging from 10 to 32 and Cronbach alpha (α) equal.83 Composite score 2 named Organization comprised of the mean score from 6 items tapping staff perceptions of organizational factors, with scores ranging from 8 to 24 and α. =.85 Composite score 3 named Staff Performance comprised of the mean score of 2 items tapping staff perceptions of treatment related work performance, with scores ranging from 3 to 8 and α. =.66 Composite score 4 named Staff Attitudes comprised of the mean score of 5 items tapping staff attitudes to the treatment model, with scores ranging from 7 to 20 with α. =

Questionnaires were distributed by post to upper management at the institutions and the staff were invited to answer them anonymously by returning it to the principal investigator at each time points

5 Method Variables of interest on demographic information were tested using chisquare and ANOVA. Multi-level method were applied to explore: 1) Covariance between (1) staff members perception of organizational leadership at T1 through T5 as related to staff members attitudes towards the treatment model at T2 through T6 2) Staff members perception of their organizational leadership at T1 through T5 as related to staff members perceptions of their employee work performance at T2 through T6 3) The staff members perception of their own organization at T1 through T5 as related to their attitudes toward the new treatment model at T2 through T6. Generalized Estimated equations (GEE) was used. 9 Results Table 2 Table 2. Overall scores for six institutions Time 1 Time 2 Time 3 Time 4 Time 5 Time 6 On six institutions: Leadership 22.6 (4.1) 21.8 (4.1) 24.7 (3.3) 22.8 (4.3) 24.2 (4.7) 24.7 (3.7) Attitudes toward the treatment model 12.4 (1.9) 12.3 (1.9) 12.9 (1.8) 12.4 (1.9) 13.1 (1.9) 13.6 (1.8) Perceived work performance 9.8 (1.4) 9.7 (1.5) 9.9 (1.4) 9.6 (1.4) 10.2 (1.4) 10.1 (1.4) Organization 17.7 (3.4) 17.1 (3.0) 18.8 (2.4) 17.8 (3.2) 18.9 (3.5) 19.2 (2.9) 10 5

treatment model at T2 through T6 2) Staff members perception of their organizational leadership at T1 through T5 as related to staff members perceptions of their employee work performance at T2

6 Preliminary findings In research question (1), Strong association between the perceived role of organizational leadership and staff members attitudes to the treatment model, Z = 2.70, p <.01. In research question (2) there was no significant association between staff members perception of organizational leadership and staff members work performance, Z = 0.93, ns. Research question (3) Significant association between staff members perception of their organization and their attitudes toward the new treatment model, Z = 5.73, p < Preliminary findings The data suggests that committed and instructive leadership can enhance staff buy-in to change when implementing new programs An organizational climate and structure that supports the implementation efforts can enhance staff buy-in to change when implementing new programs Staff performance is less influenced by organizational leadership and remains high over time. Possible causes: Self-report bias Lower level management is more important on day-to-day basis Significant differences in residents problem level Freshness of training and methodology spawns enthusiasm and a we can do it attitude 12 6

Research question (3) Significant association between staff members perception of their organization and their attitudes toward the new treatment model, Z = 5.73, p <.001.

7 Limitations No clinical outcome measures We do not know whether results of this study improved clinical outcomes of families and youth We do not know whether high staff performance or organizational leadership increased client recruitment and kept treatment period within 12 month time frame Informant bias Staff hired to work with MultifunC may be biased in favor of the method possibly influencing the finding that work performance is not influenced by leadership. 13 Future To assess the clinical significance of the treatment model an effectiveness study is underway scheduled for completion medio

bias Staff hired to work with MultifunC may be biased in favor of the method possibly influencing the finding that work performance is not influenced by

8 Thank you very much for your attention! Carl Ivar Holmen RKBU University of Tromsø 15 8

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