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Evidence-Based Practices:
Shaping Mental Health Services Toward Recovery
Assertive Community Treatment
Using General Organizational Index for Evidence-Based Practices
Overview
The General Organizational Index (GOI) measures a set of general operating
characteristics of an organization hypothesized to be related to its overall
capacity to implement and sustain any evidence-based practice. The items on
the GOI were derived from clinical experience, although the research literature
also supports the importance of many of these factors. The 6/26/02 draft version
of this index contains 10 broad principles regarding elements such as program
philosophy, training, supervision, and program monitoring. In future drafts,
several items regarding cultural competency will be added. Whereas the fidelity
scales are specific to each EBP, the GOI refers to operating characteristics
that should be very similar across the EBPs.
The GOI is intended to be a companion assessment tool used at the same time
as the EBP fidelity scale is administered. When conducting fidelity site visits,
the implementation monitors should include GOI interview items (as outlined
in the General Organizational Index Protocol).
The same set of 10 items is used for all 5 evidence-based practices (EBPs).
One item—G2—has two alternate forms, G2A and G2B. G2A, for family
psychoeducation, illness management and recovery, and supported employment,
refers to information provision. G2B, for assertive community treatment and
integrated dual disorders treatment, refers to screening. With the exception
of item G2A/B, the wording of all the items is the same for all EBPs. However,
in administering this index, the implementation monitor should tailor the language
to fit with the specific practice.
Why measure general organization characteristics?
The rationale for the use of the GOI is similar to the one given for fidelity
scales (See “Using Fidelity Scales”). Clinical experience suggests
that agencies that generally do an excellent job in implementing a practice
have the GOI elements in place within the organization. Programs scoring high
on the GOI are expected to be more effective in implementing an EBP and in achieving
desired outcomes.
We also recommend that agencies implementing an EBP use the GOI as a self-assessment
tool for monitoring programs over the course of their development (and even
after they are fully established). Considerable experience by implementers has
suggested that routine use of such indices provides an objective, structured
way to give feedback about program development.
How is the GOI used?
The assessment philosophy for the GOI mirrors that for fidelity scales.
The GOI contains simple-to-understand face-valid items that are rated on a 5-point
response format, ranging from 1 equals no implementation to 5 equals full implementation,
with intermediate numbers representing progressively greater degrees of implementation.
The response alternatives are behaviorally anchored, that is, they identify
concrete measurable elements of the practice. Our experience is that independent
evaluators using multiple sources of information make the most valid ratings.
Typical sources of information include interviews with staff, observation of
team meetings, review of charts, and observation of interventions. Although
we recommend outside raters, the GOI can also be used by program managers to
conduct self-ratings. The validity of self-ratings (or any ratings, for that
matter) depends on the knowledge of the person making the ratings, access to
accurate information pertaining to the ratings, and the objectivity of the ratings.
We encourage the use of self-ratings, with appropriate caveats regarding potential
biases that can be introduced by raters who are invested in seeing a program
“look good” or who do not fully understand the principles of the
General Organizational Index. In addition to the scales developed for independent
evaluators and program managers, companion fidelity measures intended for consumers
and family members are under development for some EBPs.
Graphing GOI
We recommend that programs implementing an EBP graph their GOI over
time. See the section on fidelity scales for a related example.
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