Validation of the extended version of the Implementation Climate Scale (ICS-X)

Background Organizational context has been identified as a critical factor for implementation effectiveness. Central to the understanding of organizational context within the literature on implementation science has been the construct of implementation climate. Reliable, valid, and pragmatic measurement of implementation climate provides a foundation for implementation research and practice. Although the Implementation Climate Scale (ICS) was developed to capture a range of policies, practices, and procedures that influence implementation success, the adaptation of the measure to the education sector resulted in the identification of additional dimensions not captured by the original scale that are potentially important for other service sectors. The purpose of this research was to validate an extended version of the ICS, referred to as the ICS-X, in behavioral health settings. Method The ICS-X is a 27-item scale incorporating nine dimensions related to an organization’s climate for the implementation of evidence-based practices. This study evaluated the psychometric characteristics of the ICS-X using data from three large studies examining the implementation of different evidence-based practices (motivational interviewing, motivational enhancement therapy, cognitive behavioral therapy, measurement-based care) in behavioral health settings. The final sample included 803 providers nested within 155 clinics. Analyses assessed the internal consistency reliability of scores on the ICS-X (Cronbach’s alpha), interrater reliability and within-organization agreement of provider ratings on the ICS-X (r wg(j) , ICC(1)), structural validity evidence (confirmatory factor analysis), and construct validity evidence (correlations with measures of other constructs). Results The analyses supported the psychometric properties of the ICS-X. We found strong results for internal consistency reliability and interrater agreement/reliability. The second-order confirmatory factor analysis demonstrated acceptable fit to the data and generally high factor loadings. The pattern of correlations across a variety of measures was consistent with expectations, supporting the construct validity of the ICS-X. Conclusion The ICS-X is a pragmatic and psychometrically sound measure that expands our understanding of the critical policies, practices, and procedures that support an implementation climate. These findings deepen our understanding of the implementation climate construct and provide a broader range of targets for implementation strategies.