What influences evidence-based treatment sustainment after implementation support ends? A mixed method study of the adolescent-community reinforcement approach

J Subst Abuse Treat. 2020 Jun:113:107999. doi: 10.1016/j.jsat.2020.107999. Epub 2020 Mar 7.

Abstract

Background: Little is known about clinician perspectives regarding the factors that support or hinder the long-term delivery (i.e., sustainment) of evidence-based treatments in community-based treatment settings.

Methods: Clinical staff from 82 community-based treatment organizations that received federal grant funding to support the delivery of the Adolescent Community Reinforcement Approach (A-CRA), an evidence-based treatment for adolescent substance use, were asked to participate in interviews focused on understanding their perspectives about the sustainment of A-CRA. Qualitative themes were identified using inductive and deductive approaches. Then the themes were dichotomized (present/absent) so that quantitative comparisons could be made between staff from organizations that sustained and did not sustain delivery of A-CRA. Administrative data about each organization in relation to federal funding support and their primary focus was also examined to explore whether these characteristics were associated with A-CRA sustainment.

Results: Staff (n = 134) representing 78 organizations participated in the interviews. Staff from organizations that had received multiple federal grants to support the delivery of A-CRA and whose primary focus was substance use rather than other conditions (mental health or primary care) were more likely to report sustaining A-CRA. Staff from sustaining organizations were more likely to report positive grant experiences and success with maintaining both organizational and external support in comparison to staff from non-sustaining organizations. Staff from non-sustaining organizations were more likely to report barriers to sustaining A-CRA, including more challenges with intervention delivery, and lack of internal support and external funding.

Conclusions: Our findings lend empirical support for implementation theories in that multiple factors appear to be associated with long-term delivery of an evidence-based treatment. Although A-CRA was generally perceived positively by staff from both organizations that sustained A-CRA and organizations that did not sustain A-CRA, inner setting factors (e.g., structural policies, leadership support and staff retention) along with outer setting factors (e.g., external funding support) were reported as key to A-CRA sustainment.

Keywords: Adolescent community reinforcement approach; Evidence-based treatment; Mixed methods; Sustainment; Youth substance use.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Humans
  • Leadership
  • Primary Health Care
  • Reinforcement, Psychology*
  • Substance-Related Disorders* / therapy