Fig. 1

Study theoretical model. Note: LOCI, Leadership and Organizational Change for Implementation strategy; MBC, measurement-based care. First-level leaders are those who administratively supervise clinicians (e.g., clinical managers). Random assignment of clinics to LOCI (vs. training and technical assistance only) is expected to cause improvement in clinic-level implementation leadership, transformational leadership, and implementation climate for digital MBC (Aim 1). Improvement in implementation leadership and transformational leadership is expected to mediate LOCI’s effect on improved clinic implementation climate (Aim 2). Improvement in clinic implementation climate is expected to mediate LOCI’s effect on improved fidelity to digital MBC as experienced by youth (Aim 3). In this study, the clinic level is synonymous with the organization level; however, this is not always the case in applications of LOCI. The LOCI strategy can be applied to organizations with multiple levels, resulting in theoretical models that describe how LOCI intervenes at multiple organizational levels to influence climate