Mixed-method study of a conceptual model of evidence-based intervention sustainment across multiple public-sector service settings

Abstract

BackgroundThis study examines sustainment of an EBI implemented in 11 United States service systems across two states, and delivered in 87 counties. The aims are to 1) determine the impact of state and county policies and contracting on EBI provision and sustainment; 2) investigate the role of public, private, and academic relationships and collaboration in long-term EBI sustainment; 3) assess organizational and provider factors that affect EBI reach/penetration, fidelity, and organizational sustainment climate; and 4) integrate findings through a collaborative process involving the investigative team, consultants, and system and community-based organization (CBO) stakeholders in order to further develop and refine a conceptual model of sustainment to guide future research and provide a resource for service systems to prepare for sustainment as the ultimate goal of the implementation process.MethodsA mixed-method prospective and retrospective design will be used. Semi-structured individual and group interviews will be used to collect information regarding influences on EBI sustainment including policies, attitudes, and practices; organizational factors and external policies affecting model implementation; involvement of or collaboration with other stakeholders; and outer- and inner-contextual supports that facilitate ongoing EBI sustainment. Document review (e.g., legislation, executive orders, regulations, monitoring data, annual reports, agendas and meeting minutes) will be used to examine the roles of state, county, and local policies in EBI sustainment. Quantitative measures will be collected via administrative data and web surveys to assess EBI reach/penetration, staff turnover, EBI model fidelity, organizational culture and climate, work attitudes, implementation leadership, sustainment climate, attitudes toward EBIs, program sustainment, and level of institutionalization. Hierarchical linear modeling will be used for quantitative analyses. Qualitative analyses will be tailored to each of the qualitative methods (e.g., document review, interviews). Qualitative and quantitative approaches will be integrated through an inclusive process that values stakeholder perspectives.DiscussionThe study of sustainment is critical to capitalizing on and benefiting from the time and fiscal investments in EBI implementation. Sustainment is also critical to realizing broad public health impact of EBI implementation. The present study takes a comprehensive mixed-method approach to understanding sustainment and refining a conceptual model of sustainment.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-014-0183-z) contains supplementary material, which is available to authorized users.

The role of collaborations in sustaining an evidence-based intervention to reduce child neglect

“…Despite the small sample, a diversity of stakeholders in systems with long-term sustainment, partial sustainment, and failed sustainment were interviewed and relatively high levels of saturation, or consistency of data, were found. Due to our focus on the sustainment phase, power struggles that affected the early stages of collaboration around SC within these sites were not examined but are described elsewhere (Aarons et al, 2014c; Hurlburt et al, 2014). Similarly, having an in-depth focus on collaboration limited our ability to describe other relevant factors that likely impact sustainment such as leadership, client populations, and funding/policy initiatives.…”

“…As part of a larger mixed-method investigation of SC sustainment (Aarons et al, 2014c), the current study examines the role of collaborations in sustaining SC service delivery across 11 state/county-level implementation efforts. This manualized curriculum-based EBI aims to reduce child neglect through home-based skills training and education for caregivers of children ages zero to five who are at-risk, or have been reported for, child neglect (Chaffin et al, 2012; Lutzker & Edwards, 2009).…”

A feasibility study of implementing grip strength measurement into routine hospital practice (GRImP): study protocol

“…Qualitative and quantitative data will be integrated through triangulation to examine (1) convergence (so results provide the same answer to the same questions), (2) expansion (are the findings collected from one data explained by another), and 3) complementary aspects (does embedding the results of one data within the other data set help contextualise overall results) [39]. The implementation costs (e.g., the training costs and costs of equipment) and NHS resource utilisation (e.g.…”

The Roles of System and Organizational Leadership in System-Wide Evidence-Based Intervention Sustainment: A Mixed-Method Study

“…Qualitative and quantitative data were drawn from a larger mixed-method investigation of EBI sustainment (Aarons, Green, et al, 2014). Previous work from this project has examined the role of collaboration in implementing and sustaining EBIs (Green et al, 2016), policymaker’s perspectives on EBI sustainment (Willging, Green, Gunderson, Chaffin, & Aarons, 2015), and the role of performance-based contracting in EBI sustainment (Willging et al, In press).…”