ORIGINAL ARTICLE Assessing Health Care Organizations’ Ability to Implement Screening, Brief Intervention, and Referral to Treatment Thomas M. Bohman, PhD, Shanti Kulkarni, PhD, Vicki Waters, MS, PA-C, Richard T. Spence, PhD, Michele Murphy-Smith, PhD, and Katherine McQueen, MD Objectives: To determine if a new measure of organizational readi- ness for change reflects site and staff role differences when imple- menting a screening, brief intervention, and referral to treatment (SBIRT) program for alcohol and drug misuse in a healthcare organization. Sample: One hundred forty-one Community Health Program (CHP) and 45 Emergency Center (EC) respondents completed the survey. Methods: Medical and ancillary staff from a Level 1 trauma hospital EC and 3 CHP clinics within a large, urban, publicly funded health-care system were asked to complete the 45-item Medical Organizational Readiness for Change (MORC) survey 5 to 7 months after the start of implementation planning. One-way ANOVAs compared the 4 sites’ responses and independent t tests compared the clinical versus administrative staff responses on 8 MORC scales. Results: There were statistically significant differences between the EC and CHP sites on Need for External Guidance, Pressure to Change, Organizational Readiness to Change, Workgroup Function- ing, Work Environment, and Autonomy Support. Clinical and ad- ministrative staff differed significantly on Need for External Guid- ance, Pressure to Change, and Organizational Readiness to Change. When change agents used the MORC data to inform their imple- mentation process, the results were positive. Conclusions: Among CHP sites, there were differences in organi- zational functioning, which were consistent with CHP implementa- tion outcomes. The MORC scales can help planners and change agents understand their organization’s current readiness to integrate screening, brief intervention, and referral to treatment services into their medical setting. Key Words: screening, brief intervention, technology transfer, SBIRT, organizational assessment, readiness to change (J Addict Med 2008;2: 151–157) S creening, brief intervention, and referral to treatment (SBIRT) within health care settings has emerged as an evidence-based practice which identifies, intervenes with and refers patients with alcohol and drug problems to appropriate care. 1–3 Studies examining SBIRT services in emergency and primary care settings have shown positive patient outcomes and cost-effectiveness, primarily for patients who engage in risky or unhealthy alcohol use. 4–8 SBIRT services vary de- pending on the setting, substance used, severity of the prob- lem, and preferred outcomes. Health care planners and ser- vice providers planning to implement SBIRT services would benefit from having an effective way to assess their organi- zation’s readiness and ability to incorporate SBIRT services. Organizational Readiness for Change encompasses agree- ment about the need for change, and optimism about the orga- nization’s ability to effectively make change(s) to their standard of care. 9,10 This article describes the adaptation of Texas Chris- tian University’s Organizational Readiness for Change (ORC) 11 instrument, and the use of the subsequent Medical Organiza- tional Readiness for Change (MORC), in a large, urban, publicly- funded health care system. The MORC was administered to assess overall readiness profiles in different sites within the urban hospital district and between two categories of staff roles in preparation for implementation of a new SBIRT program. The primary aim of the present study was to determine whether the MORC was able to identify differences among sites and between staff roles in readiness-to-change dimensions. The ORC was developed by Simpson and colleagues as part of the Texas Christian University Program Change Model (PCM) and designed for the transfer of technology from research to practice in the addiction treatment field. It focused on strategic planning, addressed both staff and orga- nizational level attributes, and was key to assessment of organizational functioning during the adoption, trial imple- mentation, and widespread implementation stages outlined in the PCM. 12 The ORC focused particularly on assessing or- ganizational readiness for change as part of technology trans- fer of evidence-based practices in specialty substance abuse treatment organizations. It assessed agency needs, institu- tional resources, staff attributes, and organizational climate. From Addiction Research Institute (TMB, RTS, MM-S), School of Social Work, University of Texas at Austin, Austin; Department of Internal Medicine (KM) and School of Allied Health Sciences (VW), Baylor College of Medicine, Houston, Texas; and Department of Social Work (SK), College of Health and Human Services, University of North Carolina—Charlotte, Charlotte, North Carolina. Received October 10, 2007; accepted May 15, 2008. Send correspondence and reprint requests to Thomas M. Bohman, PhD, Addiction Research Institute/GCATTC, Center for Social Work Re- search, University of Texas at Austin, 1717 West 6th Street, Suite 335, Austin, TX 78703. e-mail: bohman@mail.utexas.edu The views and opinions contained in the publication do not necessarily reflect those of SAMHSA or the US Department of Health and Human Services, and should not be construed as such. Copyright © 2008 American Society of Addiction Medicine ISSN: 1932– 0620/08/0203-0151 J Addict Med • Volume 2, Number 3, September 2008 151