Availability, Responsiveness, and Continuity (ARC)

Child welfare and mental health agencies

ARC is an organizational change strategy for child welfare and mental health agencies. Through a 2- to 3-year process, ARC is designed to improve organizational culture and climate, increase job satisfaction and commitment, support the adoption and success of evidence-based practices (EBPs), reduce staff turnover, and improve clients' outcomes. ARC uses three strategies and the support of an external change agent called the ARC specialist to do this:

• The first ARC strategy embeds five principles of service system effectiveness that focus organizations' priority setting.
• The second ARC strategy promotes shared mental models among front-line staff and administrators that support service innovation.
• The third ARC strategy uses organizational component tools to identify and address barriers to service improvement and effectiveness.

Charles Glisson

• Email: cglisson@utk.edu
• Phone: (865) 974-9143

Publicly available information indicates there is some training available for this program. See contact info.

Manual Information

There is a manual that describes how to deliver this program.

Training Information

There is training available for this program.

Pre-Implementation Materials

There are pre-implementation materials to measure organizational or provider readiness for Availability, Responsiveness, and Continuity as listed below.

An assessment tool (OSC) and associated strategies for pre-implementation are described in their recent book from Oxford University Press entitled Building Cultures and Climates for Effective Human Services, https://global.oup.com/academic/product/building-cultures-and-climates-for-effective-human-services-9780190455286?q=hemmelgarn%20and%20glisson&lang=en&cc=us#

"What is included in the Relevant Published, Peer-Reviewed Research section?"

• Glisson, C., Dukes, D., & Green, P. D. (2006). The effects of the ARC organizational intervention on caseworker turnover, climate, and culture in children's service systems. Child Abuse & Neglect, 30(8), 855-880. https://doi.org/10.1016/j.chiabu.2005.12.010

  Type of Study: Randomized controlled trial

  Participants: 235

  Sample / Population:

  • Age — Mean=38.46 years
  • Race/Ethnicity — 16% Minority
  • Gender — 79% Female
  • Status —

    Participants were child welfare and juvenile justice workers.

  Location/Institution: Twenty-five regions in a Southeastern state in the United States

  Summary:

  The purpose of the study was to examine the effects of the Availability, Responsiveness, and Continuity (ARC) organizational intervention strategy on caseworker turnover, climate, and culture in a child welfare and juvenile justice system. Participants were randomly assigned to either the ARC organizational intervention condition or to a control condition. Measures utilized include the Organizational Climate Survey (OCL) and the Shortform Assessment for Children (SAC). Results indicate that the ARC organizational intervention reduced the probability of caseworker turnover by two-thirds and improved organizational climate by reducing role conflict, role overload, emotional exhaustion, and depersonalization in both urban and rural case management teams. Limitations include significant time commitments and costs associated with the ARC intervention, lack of generalizability of findings to other children’s service systems, and the study does not assess the impact of the ARC intervention on outcomes for children and families.

  Length of controlled postintervention follow-up: 1 year.

• Glisson, C., Schoenwald, S. K., Hemmelgarn, A. L., Green, P. D., Dukes, D., Armstrong, K. S., & Chapman, J. E. (2010). Randomized trial of MST and ARC in a two-level evidence-based treatment implementation strategy. Journal of Consulting and Clinical Psychology, 78(4), 537-550. https://doi.org/10.1037/a0019160

  Type of Study: Randomized controlled trial

  Participants: 615

  Sample / Population:

  • Age — 9–17 years
  • Race/Ethnicity — 91% Caucasian, 5% African American, 2% Biracial, 1% Hispanic, 1% Native American, and 1% Other
  • Gender — 69% Male and 31% Female
  • Status —

    Participants were youth from community mental health programs serving youth that are socially and economically disadvantaged.

  Location/Institution: Fourteen rural Appalachian counties in Tennessee

  Summary:

  The purpose of the study was to assess the effectiveness of a 2-level strategy for implementing evidence-based mental health treatments for delinquent youth. Participants were randomly assigned to four treatment conditions 1) Multisystemic Therapy (MST) plus Availability, Responsiveness, and Continuity (ARC); 2) MST only; 3) ARC only; or 4) control. Measures utilized include the Child Behavior Checklist (CBCL) and the Supervisor Adherence Measure (SAM). Results indicate that at 6 months, treatment outcomes for youth total problem behavior in the MST plus ARC condition was at a nonclinical level and significantly lower than in other conditions. Total problem behavior was equivalent and at nonclinical levels in all conditions by the 18-month follow-up, but youth in the MST plus ARC condition entered out-of-home placements at a significantly lower rate (16%) than youth in the control condition (34%). Limitations include reliance on self-reported measures, missing data, and some analyses of MST fidelity and implementation had less power because of the smaller sample size.

  Length of controlled postintervention follow-up: 6, 12, and 18 months.

• Glisson, C., Hemmelgarn, A., Green, P., Dukes, D., Atkinson, S., & Williams, N. (2012). Randomized trial of the ARC organizational intervention with community-based mental health programs and clinicians serving youth. Journal of the American Academy of Child and Adolescent Psychiatry, 51(8), 780-787. https://doi.org/10.1016/j.jaac.2012.05.010

  Type of Study: Randomized controlled trial

  Participants: 197

  Sample / Population:

  • Age — Mean=33 years
  • Race/Ethnicity — 83% Caucasian
  • Gender — 68% Female
  • Status —

    Participants were clinicians from community mental health programs serving youth who were socially and economically disadvantaged.

  Location/Institution: Southeastern state in the United States

  Summary:

  The purpose of the study was to test whether an organizational intervention labeled Availability, Responsiveness, and Continuity (ARC) could improve the organizational social contexts of community-based mental health programs for youth. Participants were randomized to either ARC or control conditions. Measures utilized include the Organizational Social Context (OSC). Results indicate that organizational culture, climate, and work attitudes were significantly improved in the ARC condition after 18 months. Clinicians in programs assigned to ARC reported less rigid, less centralized, and less apathetic organizational cultures; more engaged and functional organizational climates with less role conflict; and work attitudes with improved morale, job satisfaction, and organizational commitment. Limitations include participating clinicians were necessarily aware of whether their programs were assigned to the ARC intervention or control condition, results may not be generalized beyond the participating program due to mostly serving participants from low-income and socially disadvantage youths, and lack of follow-up.

  Length of controlled postintervention follow-up: None.

• Glisson, C., Hemmelgarn, A., Green, P., & Williams, N. (2013). Randomized trial of the Availability, Responsiveness and Continuity (ARC) organizational intervention for improving youth outcomes in community mental health programs. Journal of the American Academy of Child and Adolescent Psychiatry, 52(5), 493-500. https://doi.org/10.1016/j.jaac.2013.02.005

  Type of Study: Randomized controlled trial

  Participants: 556 (154 clinicians and 402 youth)

  Sample / Population:

  • Age — Children: Mean=12 years; Adults: Mean=32 years
  • Race/Ethnicity — Children: 76% Caucasian, 25% African American, and 3% Hispanic; Adults: 83% Caucasian
  • Gender — Children: 60% Male, Adults: 73% Female
  • Status —

    Participants were community mental health programs that served youth between the ages of 5 and 18 years.

  Location/Institution: Southeastern state in the United States

  Summary:

  The purpose of the study was to assess whether the Availability, Responsiveness, and Continuity (ARC) organizational intervention improved youth outcomes in community-based mental health programs. The second objective was to assess whether programs with more improved organizational social contexts following the 18-month ARC intervention had better youth outcomes than programs with less improved social contexts. Participants were cluster randomized by program (9 programs randomly assigned to ARC and 9 programs randomly assigned to control) after matching programs based on staff size and client population. Measures utilized include the Shortform Assessment for Children (SAC) and the Organizational Social Context (OSC). Results indicate that youth outcomes were significantly better in the programs that completed the 18-month ARC intervention. Analyses also showed that youth outcomes were best in the programs with the most improved organizational social contexts following the 18-month ARC intervention. Limitations include concerns that youth were assigned via cluster randomization by randomly assigning programs to ARC and control, youth do not represent a specific population to which the results can be generalized, and lack of follow-up.

  Length of controlled postintervention follow-up: None.

• Glisson, C., Williams, N. J., Hemmelgarn, A., Proctor, E., & Green, P. (2016). Aligning organizational priorities with ARC to improve youth mental health service outcomes. Journal of Consulting and Clinical Psychology, 84(8), 713–725. https://doi.org/10.1037/ccp0000107

  Type of Study: Randomized controlled trial

  Participants: 1080 (475 clinicians and 605 youth)

  Sample / Population:

  • Age — Children: 5–18 years; Adults: Mean=32 years
  • Race/Ethnicity — Children: 66% White and 26% African American; Adults: 83% White
  • Gender — Children: 54% Male, Adults: 82% Female
  • Status —

    Participants were community mental health programs that served youth between the ages of 5 and 18 years.

  Location/Institution: Midwest United States

  Summary:

  The purpose of the study was to assess the effect of the Availability, Responsiveness, and Continuity (ARC) intervention on youth outcomes and the mediating role of organizational priorities as a mechanism linking the ARC intervention to outcomes. Participants were randomly assigned to the 3-year ARC intervention or a non-treatment control condition. Measures utilized include the ARC Principles Questionnaire (APQ) and the Shortform Assessment for Children (SAC). Results indicate that the rate of improvement in youths’ psychosocial functioning in agencies assigned to the ARC condition was 1.6 times the rate of improvement in agencies assigned to the control condition. Limitations include concerns that youth were assigned via cluster randomization by randomly assigning programs to ARC and control, youth do not represent a specific population to which the results can be generalized, and missing data.

  Length of controlled postintervention follow-up: 6 and 12 months.

• Note: The following study was not included in rating Availability, Responsiveness, and Continuity on the Scientific Rating Scale.

  Williams, N. J., Glisson, C., Hemmelgarn, A., & Green, P. (2017). Mechanisms of change in the ARC organizational strategy: Increasing mental health clinicians' EBP adoption through improved organizational culture and capacity. Administration and Policy in Mental Health and Mental Health Services Research, 44(2), 269–283. https://doi.org/10.1007/s10488-016-0742-5

  Summary:

  The purpose of the study was to test the cross-level change mechanisms that link the implementation of Availability, Responsiveness, and Continuity (ARC) to mental health clinicians’ evidence-based program (EBP) adoption and use. Participants were randomly assigned to the ARC intervention or a non-treatment control condition. Measures utilized include the ARC Principles Questionnaire (APQ) and the Organizational Social Context (OSC). Results indicate that ARC increased clinicians’ EBP adoption and use at 12-month follow-up. These effects were mediated by improvement in organizational proficiency culture leading to increased clinician intentions to adopt EBPs and by reduced job-related EBP barriers. Results also indicate that the organizational culture-EBP intentions mechanism was the primary carrier of ARC’s effects on clinicians’ EBP adoption and use. Limitations include reliance on self-reported measures and generalizability of results due to gender and ethnicity of participants. Note: This article was not used for rating ARC in the Child Welfare Worker Development and Support Programs topic area since child welfare workers were not the participants in the study.

• Hemmelgarn, A. L., & Glisson, C. (2018). Building organizational cultures and climates for effective human services: Understanding and improving organizational social contexts with the ARC model. Oxford University Press. https://global.oup.com/academic/product/building-cultures-and-climates-for-effective-human-services-9780190455286?cc=us&lang=en&