Long-Term Sustainability of Evidence-Based Practices in Community Mental Health Agencies

Abstract

This study examined rates of sustainability, defined as program continuation, and factors associated with sustainability 6 years after full implementation of five evidence-based practices in 49 sites in the National Implementing Evidence-Based Practices Project. Based on interviews with agency leaders and state leaders, 47 % of sites sustained the practice for 6 years, 16 % restarted the practice after a period of discontinuation, and 37 % discontinued the practice permanently. Agency leaders from discontinuing sites identified inadequate financial support, lack of prioritization, and workforce issues as barriers to continuation. Adequate financing, ongoing supervision, and monitoring of fidelity and outcome may promote long-term sustainability.

The Sustainability of Evidence-Based Interventions and Practices in Public Health and Health Care

“…Many studies have used a qualitative or mixed-methods approach to understand barriers and facilitators to sustainability (5, 10, 37). Consistent with organizational contexts in community settings (e.g., schools), many of these studies, particularly those in clinics or hospitals, suggest that funding, organizational factors and support (e.g., champions, supervision), and practitioner/workforce characteristics (e.g., turnover) are particularly influential (13,98,125 …”

“…Prospective, multilevel, and mixed-methods study designs are ideal for studying sustainability (94, 98). For example, quantitative surveys could be used to examine predictors of sustainability in multiple waves over time in conjunction with measures of sustainability outcomes, whereas qualitative surveys (e.g., in-depth case studies, interviews, ethnographic research) could be conducted among stakeholders at multiple levels to contextualize the findings within specific organizational settings, to provide insight into why programs were or were not sustained, and to understand differential processes that occurred across organizations (13,98,131,147). Comparative case studies provide another promising approach that has been used successfully in sustainability research (114).…”

Comparing the Costs and Acceptability of Three Fidelity Assessment Methods for Assertive Community Treatment

“…H. McGrew, Bond, Dietzen, & Salyers, 1994;McGuire et al, in press; McHugo, Drake, Teague, & Xie, 1999;van Vugt et al, 2011). Fidelity monitoring is a critical tool for providing developmental feedback, either in program start-up for learning program principles and practices or as an important component in supporting the long-term sustainability of such practices (Bond et al, 2014). Assertive community treatment (ACT) is one such evidence-based mental health practice benefitting from fidelity monitoring to develop and maintain quality services according to the model.…”

Future Directions for the Implementation and Dissemination of Statewide Developmental-Behavioral Pediatric Integrated Health Care

“…Although spatial constraints preclude a detailed listing of all instruments utilized in this context, 2 the take-home point is that heavy investment of resources and reciprocal exchange between clinicians and researchers enables a thorough, evidentiary approach to services from initial assessment to discharge (Lyon et al, 2011). This is consistent with the goals of disseminating science to practice environments (see Southam-Gerow & Dorsey, 2014, for the introduction to a special issue of this journal on this topic) and the accumulating findings concerning optimal methods of training (Beidas & Kendall, 2010;Rakovshik & McManus, 2010) and sustainability of practices implemented in applied environments (Bond et al, 2014).…”