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• What is the most important action that a coalition or organization needs to focus on to increase the chances of sustaining a program or policy?

Sustaining Successful Prevention Efforts – Part 1Sustainability: The Actions That Lead to Sustainability and Long-Term OutcomesHayden D. Center, Jr., Ph.D., LPCAugust 20, 2019

Disclaimer

The views expressed in this webinar do not necessarily represent the views, policies, and positions of the Substance Abuse and Mental Health Services Administration or the U.S.

Department of Health and Human Services.

This webinar is being recorded and archived, and will be available for viewing after the webinar. Please contact the webinar facilitator if you have any concerns or questions.

Purpose of the PTTC

•Develop and disseminate tools and strategies needed to improve the quality of substance abuse prevention efforts

•Provide training and learning resources to prevention professionals

•Develop tools and resources to engage the next generation of prevention professionals

CA

NV

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Pacific Southwest

Mark Your Calendars!

Monthly Media Series:

Sustaining Successful Prevention Efforts – Part IISeptember 24, 20193:00 PM – 4:30 PM Pacific

Hayden D. Center, Jr., Ph.D., LPC, was most recently on faculty at Auburn University at Montgomery in the Department of Psychology, where he taught for ten years. He also has worked as a consultant in alcohol, tobacco, and other drug abuse prevention since 1987. Hayden has worked in the field of prevention for more than 30 years. He has worked with numerous agencies and organizations at the national, state, and local levels as an evaluator, including three Drug-Free Community grants. He is also working on the development of a sustainability toolkit that will be released in the Fall of 2019. He and three colleagues will present an overview of the toolkit at the National Prevention Network (NPN) Conference in Chicago in 2019.

Implementation and Sustainability

Our Roadmap

• In this webinar we will look at the actions that are important to consider to ensure that successful implementation efforts are maintained. There will be an emphasis on implementation actions that may it more likely that a program will ultimately sustain.

Sustainability and Implementation Science• Once we achieve important outcomes utilizing the practical

steps outlined in implementation science, then the efforts to sustain the program need to continue and become even more fortified.

Keys to Sustainability

Unlocking the Doors to Effective Prevention and Positive Outcomes

Sustainability and the Strategic Prevention Framework (SPF)

AssessmentCapacityPlanningImplementationEvaluation

At the Core…Sustainability and Cultural Competence

History of Sustainability Moving from Funding

Focused…

Historically, substance abuse prevention has been directed by the funds available and many times the funder.

Why Should Prevention Strategies Be Continued?

There are documented reductions in substance abusebehaviors.

Prevention strategies are more cost effective when comparedto treatment and incarceration costs.

The cost savings and impact on related problems will be clearto funders and community members.

What is Sustainability? Sustainability is a process of ensuring

an adaptive and effective prevention system.

Sustainability builds capacity among diverse stakeholders.

Sustainability maintains positive outcomes.

Sustainability • First, we view sustainability as a change process with specific sustainability action steps to strengthen system infrastructure and innovation attributes that are necessary to sustain a particular innovation

• Second, ensuring an adaptive prevention system is part of the sustainability process. The system must be receptive to change, thus creating an environment for innovations to adapt to the system, if necessary, to which they are introduced

Three Keys to Sustainability

ORGANIZATIONAL CAPACITY: assure that the community agencies, organizations and institutions have adequate internal organizational capacity to achieve positive outcomes

EFFECTIVENESS: assure effectiveness and alignment of the prevention system to produce positive outcomes

COMMUNITY SUPPORT: cultivate community support for the prevention system and its positive outcomes

Organizational Capacity Action Step 1:

• Structures and formal linkages: Develop administrative structures and formal linkages that support comprehensive, collaborative evidence-based strategies to achieve and sustain targeted reductions in substance using behaviors.

Structures and Formal Linkages

The administrative unit(s) responsible for the integration, use, and oversight of the innovative infrastructure element or program must have the structures and capacity necessary to carry out administrative functions related to an innovation.

Research at both the community and state levels identifies collaboration among agencies or partners as an important factor for facilitating sustainability.

Organizational Capacity

Action Step 2:

• Policies and procedures: Adopt supportive policies and procedures that allow community agencies, organizations and institutions to respond as data indicates.

Policies and Procedures

Codification of sustained integration of the innovation in an organization’s operations communicates organizational commitment and sets new norms for behavior.

Failure to implement formal policies and procedures can create political obstacles to sustainability, sending mixed messages about the desirability of the innovation and expectations for sustaining it.

Policies andProcedures

• Policies and procedures should assure that the innovation remains part of the routine practice of the organization, even after the top management who advocated sustaining the innovation leaves the organization. In some cases changes in state or local laws may be required to ensure the integration of the innovation into the system.


Action Step 3:

• Resources: Secure diverse resources (human, technical, physical and financial) that support the prevention system.


Funding is only one resource among many that are needed; other resources needed to sustain a system include human, physical, technological, and informational resources

Training of staff to provide technical assistance supporting the use of the innovation is also important for its sustained use.


Action Step 4:

• Expertise: Acquire appropriate expertise that enables the system to prioritize, plan for, and carry out evidence based strategies to reduce substance use/abuse and its consequences


Goodman et al. (1997) points to the importance of expertise in developing community and organizational support and increasing community and practitioner competence.

Expertise is needed to carry out the functions associated with the innovation, as well as with the strategic planning, in order to plan for sustainability.


Action Step 5:

• Quality and accountability: Assess implementation quality• How do we assure quality

implementation and accountability of strategies?

Assure that the strategy matches the cultural, developmental and gender characteristics of the population.

Receive training or technical assistance to support appropriate implementation of the intervention.

Action 5 Step Continued

Track Track implementation through process evaluation.

Deliver Deliver the program’s core components with fidelity.

WorkWork with the developer to understand the core components that are needed for demonstrated outcomes.

Ensuring Effectiveness

Action Step 6:

• Reach and alignment: Assess the reach and alignment of the strategy to ensure that it aligns culturally and otherwise with the targeted population and is delivered to an adequate number of people in order to achieve the community outcomes desired• Why do we assess the effectiveness of

each strategy?• How do we assure effectiveness of a

strategy?• What should we do if strategies have

not shown to be effective?


A number of studies suggest that, regardless of the capacity of the organization to support the continued implementation of the innovation, the innovation is not likely to be sustained if it does not meet the needs of intended user.

The innovation cannot be too complex to implement; further, it must be compatible with the philosophical orientation and agenda of users, and users must perceive a benefit beyond that of current practices.


Action Step 7:

Effectiveness: Assure that the strategy being implemented is documented as effective for achieving the desired outcomes

How can we ensure that our strategies are reaching and aligning with the target population in order to reach population-level change?

Develop a logic model that identifies the strategies currently being implemented and their relationship to the targeted outcome behavior

Conduct a gaps analysis to ensure that there are effective strategies that will logically work together to result in outcome behavior change

Ensure that current strategies collectively reach the target population


Conduct process evaluation and use the results to ensure ongoing implementation quality and the integrity of the innovation, and increase knowledge of the innovation’s effectiveness.

The quality of implementation of the innovation should be monitored to ensure fidelity, strength, and reach.

Cultivating Community Support Action Step 8:

Relationships: Develop and nurture positive relationships among all key stakeholders to create a system of awareness and support in which all interested parties share mutual trust and a willingness to work together strategically

Cultivating Community Support

Establish and/or maintain positive relationships among the innovation’s developers, organizational decision-makers, implementers, and evaluators.

Research that focuses on sustainability of innovative educational programs and practices points to the importance of the relationship among the implementing teachers and innovation developer.


• Champions: Turn stakeholders into system leaders and champions who advocate for policies and actions both within the system and throughout the community that supports their long term strategic outcomes


Research repeatedly points to the importance of leaders and champions (influential and proactive individuals inside or outside of a system) in the sustainability process.

Formal and informal leaders within adopting systems, as well as champions who proactively promote an innovation from inside or outside of a system, are critical to creating an environment that supports and facilitates sustaining innovations.

Discussion Question

• For just a moment think about the different types of champions that are needed at different points in the implementation and sustainability process.

• What are some examples of the effective use of champions?

• Please take a moment and enter your comments in the chat pod


• Ownership: Encourage ownership -we tend to value that which is ours and are more likely to sustain that which we value


Individuals are more likely to comply with institutionalization processes because they are personally committed to them.

Studies of the implementation of prevention interventions through community-based processes suggest that facilitating active citizen involvement and community ownership) are important for sustaining a given intervention or process in the community.

Outcomes of Sustainability Planning

Communities will build their capacity to reduce substance use consequences by:• Having a flexible response system that

allows them to strategically address substance abuse issues and achieve positive, sustainable results.

• Supporting outcome based planning (adopting and integrating the

• Strategic Prevention Framework into the community prevention system).

• Integrating an effective decision-making process that enables them to become a valued problem-solving group.

• Effectively using limited resources.

Johnson et.al. (2017) Primary data were collected by a telephone

interview/web survey five and one-half years after the SPF SIG ended.

19 coalitions (70%) were still active five and one-half years later. Further, 88 EBPIs and non-EBPIs were implemented by 27 county SPF SIG coalitions. Twenty-one (21) of 27 coalitions (78%) implemented one to three EBPIs, totaling 37 EBPI implementations.

Johnson et. al. (2017)

Based on primary survey data on 29 of the 37 EBPI implementations, 28 EBPIs (97%) were sustained between two and five and one-half years while 22 EBPI implementations (76%) were sustained for five and one-half years.

Increases in data resources (availability of five types of prevention data) was a strong predictor of length of EBPI sustainability

Johnson et.al. (2017) Positive change in extramural funding

resources and level of expertise during SPF SIG implementation, as well as level of coalition formalization at the end of the SPF SIG predicted EBPI sustainability length.

One intervention attribute (trialability) also predicted length of sustainability.

Rhodes, Bumbarger, & Moore (2012)

• This study examined factors associated with the predicted and actual post-funding sustainability of evidencebasedinterventions implemented as part of the Pennsylvania Commission on Crime and Delinquency’s Research-Based Delinquency and Violence Prevention Initiative. Correlates of predicted post-funding sustainability included program staff, overall school support, and school administrator support


• Five years post-funding 33% of the interventions were no longer operating, 22% were operating at a reduced level, and 45% were operating at the same level or a higher level than the final year of funding.

• This study suggests that sustainability planning is a key factor in post-funding sustainability.


• A key finding in this study was that even 5 years post-PCCD funding the majority of interventions still were being implemented, albeit at reduced levels in some cases. Additionally, 77% of all interventions were able to obtain permanent and/or temporary funding after the 4-year PCCD funding period ended, and only a small portion of interventions received additional funding from PCCD.

Rhodes, Bumbarger, & Moore (2012) • This study suggests that obtaining and

maintaining school support for evidence-based interventions should be a priority, as school support is associated with predicted post-funding sustainability, and predicted sustainability is associated with actual post funding sustainability.


• Compared with their non-sustained counterparts, sustained programs were more likely to report connection and communication with stakeholders, fit between program characteristics and organizational capacity, knowledge of the program, communication with the program trainer/developer, and sustainability planning.

Welsh et.al. (2016) • The Communities That Care (CTC)

coalition-based prevention system and the PROSPER community-university partnership model. A study of 110 CTC sites in Pennsylvania found that 90% of coalitions continued after the three-year initial funding period, with 3–8% of sites terminating each year after. Studies suggest that some factors may be uniquely important for sustaining coalitions, including board/team functioning, data/evaluation resources, and planning for sustainability.

Welsh et.al. (2016) • “Overall, we found that organizational

support for program implementation (connection to a high functioning coalition, outreach to community stakeholders), better program fit (i.e., lack of reasons for changing the program model), knowledgeable, well-trained program implementers, and sustainability planning are key predictors of sustainability across program type.”

Welsh et.al. (2016)

• Findings indicate that it is not simply connection to a coalition (which did not significantly differ between sustained and unsustained programs), but connection to a high-functioning coalition that is an important sustainability correlate.

Welsh et.al. (2016) • A high-functioning coalition, characterized

by a strong collective mission and vision, with mutually established priorities and fidelity to a shared conceptual model of data-driven decision making, may be much more invested (collectively) in the sustainability of a program that is seen more tangibly as a mechanism for achieving the collective good.

Scutter et.al. (2017)

• In the present study ,we found that implementers who communicated frequently with the program's trainers and had greater knowledge of the program's logic model were connected to programs that had an increased likelihood of being sustained.

Scutter et.al. (2017) • Champions were one of the most important

factors to sustainment, and facilitated sustainability at high levels (i.e. only 25% reported the lack of a champion as a barrier). Champions were described as “make[ing] PCIT happen no matter what” and as “culture carriers” or “creating a positive contagion”.

Scutter et.al. (2017) • Integration was the strongest predictor of

sustainment, positively predicting both the PSAT and overall ratings of sustainability. Integration into existing practices was defined similarly to concepts such as institutionalization or routinization. Initiatives reported common strategies for integration (e.g. training/educating other professionals, expanding PCIT to new settings/ populations, embedding into agency practices

Remember • The Keys to Sustainability are about recognizing, assessing and building on the many strengthsthat our communities have tooffer.

References

Goodman RM, Steckler A: A model for the institutionalization of health promotion programs. Fam Community Health. 1989, 11: 63-78.Johnson, K., Collins, C., Shamblen, S., Kenworthy, T, & Wandersman, A. (2017) Long-Term Sustainability of Evidence-Based Prevention Interventions and Community Coalitions Survival: a Five and One-Half Year Follow-up Study. Prevention Science, 810, 610-620.Johnson, K., Hays, C., Center, H., & Daley, C. (2004). Building capacity and sustainable prevention innovations: a sustainability planning model. Evaluation and Program Planning, 27, 135–149.

References

Rhodes, B.L., Bumbarger, B.K., Moore, J.E., (2012). The Role of a State-Level Prevention Support System in Promoting High-Quality Implementation and Sustainability of Evidence-Based Programs. American Journal of Community Psychology, 50, 386-401.Scudder et al. Health Research Policy and Systems (2017) 15:102 DOI 10.1186/s12961-017-0230-8.Welsh, J.A., Chilenski, S.M., Johnson, L., Greenberg, M.T., & Spoth, R. L. (2016). Pathways to Sustainability: 8-Year Follow-Up From the PROSPER Project. Primary Prevent 37:263–286

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