Mixed-method study of a conceptual model of evidence-based intervention sustainment across multiple public-sector service settings
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BACKGROUND: This 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. METHODS: A 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. DISCUSSION: The 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.
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Sustainment is critical because the ultimate public health impact of EBPs is dependent on long-term use.
“Sustainment is also critical because the ultimate public health impact of EBPs is dependent on long-term use [73].”
From Translating economic evaluations into financing strategies for implementing evidence-based practices (2021) · cites this paper as [73]
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The ‘Millionaires Tax’ And Mental Health Policy In California
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Personality Disorders of Childhood and Adolescence
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Frontiers in Public Health Services and Systems Research
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Issues of maltreatment and abuse.
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Woodward, E. N., Singh, R. S., Ndebele‐Ngwenya, P., Castillo, A. M., Dickson, K. S., & Kirchner, J. E. (2021) · Implementation Science Communications · doi:10.1186/s43058-021-00146-5 · Cited by 274 · see citing works
Aarons, G. A., Green, A. E., Trott, E., Willging, C. E., Torres, E. M., Ehrhart, M. G., & Roesch, S. C. (2016) · Administration and Policy in Mental Health and Mental Health Services Research · doi:10.1007/s10488-016-0751-4 · Cited by 251 · see citing works
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The Fault Lines of Leadership: Lessons from the Global Covid-19 Crisis
Maak, T., Pless, N. M., & Wohlgezogen, F. (2021) · Journal of Change Management · doi:10.1080/14697017.2021.1861724 · Cited by 104 · see citing works
Moullin, J. C., Sklar, M., Ehrhart, M. G., Green, A., & Aarons, G. A. (2021) · Implementation Science · doi:10.1186/s13012-021-01152-w · Cited by 82 · see citing works
Self-citationMeza, R. D., Triplett, N. S., Woodard, G. S., Martin, P., Khairuzzaman, A. N., Jamora, G., & Dorsey, S. (2021) · Implementation Science · doi:10.1186/s13012-021-01104-4 · Cited by 76 · see citing works
Advancing the pragmatic measurement of sustainment: a narrative review of measures
Moullin, J. C., Sklar, M., Green, A., Dickson, K. S., Stadnick, N. A., Reeder, K., & Aarons, G. A. (2020) · Implementation Science Communications · doi:10.1186/s43058-020-00068-8 · Cited by 72 · see citing works
Self-citationWillging, C. E., Aarons, G. A., Trott, E. M., Green, A. E., Finn, N. K., Ehrhart, M. G., & Hecht, D. B. (2015) · Administration and Policy in Mental Health and Mental Health Services Research · doi:10.1007/s10488-015-0681-6 · Cited by 71 · see citing works
Self-citationImplementing Exercise in Healthcare Settings: The Potential of Implementation Science
Czosnek, L., Rankin, N. M., Zopf, E. M., Richards, J. A., Rosenbaum, S., & Cormie, P. (2019) · Sports Medicine · doi:10.1007/s40279-019-01228-0 · Cited by 58 · see citing works
Hunter, S. B., Han, B., Slaughter, M. E., Godley, S. H., & Garner, B. R. (2017) · Implementation Science · doi:10.1186/s13012-017-0606-8 · Cited by 56 · see citing works
Akin, B. A., Strolin-Goltzman, J., & Collins‐Camargo, C. (2017) · Children and Youth Services Review · doi:10.1016/j.childyouth.2017.09.007 · Cited by 54 · see citing works
Squires, A. P., Murali, K. P., Greenberg, S. A., Herrmann, L. L., & D’Amico, C. O. (2019) · The Gerontologist · doi:10.1093/geront/gnz150 · Cited by 54 · see citing works
Translating economic evaluations into financing strategies for implementing evidence-based practices
Dopp, A. R., Kerns, S. E. U., Panattoni, L., Ringel, J. S., Eisenberg, D., Powell, B. J., Low, R., & Raghavan, R. (2021) · Implementation Science · doi:10.1186/s13012-021-01137-9 · Cited by 52 · see citing works
The role of collaborations in sustaining an evidence-based intervention to reduce child neglect
Green, A. E., Trott, E. M., Willging, C. E., Finn, N. K., Ehrhart, M. G., & Aarons, G. A. (2015) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2015.11.013 · Cited by 49 · see citing works
Self-citationØvretveit, J., Mittman, B. S., Rubenstein, L. V., & Ganz, D. A. (2017) · International Journal of Health Care Quality Assurance · doi:10.1108/ijhcqa-01-2017-0019 · Cited by 46 · see citing works
Psychosocial Treatment Options for Major Depressive Disorder in Older Adults
Renn, B. N., & Areán, P. A. (2017) · Current Treatment Options in Psychiatry · doi:10.1007/s40501-017-0100-6 · Cited by 43 · see citing works
Zakumumpa, H., Kimani, M., Ntawiha, W., & Maniple, E. (2021) · PLoS ONE · doi:10.1371/journal.pone.0254214 · Cited by 39 · see citing works
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Akin, B. A., Brook, J., Lloyd, M. H., Bhattarai, J., Johnson‐Motoyama, M., & Moses, M. (2016) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2016.06.002 · Cited by 36 · see citing works
Zakumumpa, H., Taiwo, M. O., Muganzi, A. M., & Ssengooba, F. (2016) · Human Resources for Health · doi:10.1186/s12960-016-0160-5 · Cited by 35 · see citing works
The Role of Leadership in Organizational Implementation and Sustainment in Service Agencies
Moullin, J. C., Ehrhart, M. G., & Aarons, G. A. (2017) · Research on Social Work Practice · doi:10.1177/1049731517718361 · Cited by 34 · see citing works
Self-citation“Creative Financing”: Funding Evidence-Based Interventions in Human Service Systems
Jaramillo, E. T., Willging, C. E., Green, A. E., Gunderson, L. M., Fettes, D. L., & Aarons, G. A. (2019) · The Journal of Behavioral Health Services & Research · doi:10.1007/s11414-018-9644-5 · Cited by 33 · see citing works
Self-citationCarcone, A. I., Coyle, K. K., Gurung, S., Cain, D. N., Dilones, R. E., Jadwin-Cakmak, L. A., Parsons, J. T., & Naar, S. (2019) · JMIR Research Protocols · doi:10.2196/11202 · Cited by 31 · see citing works
Zakumumpa, H., Bennett, S., & Ssengooba, F. (2017) · Implementation Science · doi:10.1186/s13012-017-0578-8 · Cited by 30 · see citing works
Johnson, E. E., MacGeorge, C. A., King, K. L., Andrews, A. L., Teufel, R. J., Kruis, R. D., Hale, K. C., Ford, D. W., & Sterba, K. R. (2021) · Academic Pediatrics · doi:10.1016/j.acap.2021.04.025 · Cited by 30 · see citing works
Shelton, R. C., Charles, T.-A., Dunston, S. K., Jandorf, L. H., & Erwin, D. O. (2017) · Translational Behavioral Medicine · doi:10.1007/s13142-017-0491-3 · Cited by 31 · see citing works
Betancourt, T. S., Hansen, N. B., Farrar, J., Borg, R. C., Callands, T. A., Desrosiers, A., Antonaccio, C. M., Williams, M. J., Bangura, J., & Brennan, R. T. (2020) · Psychiatric Services · doi:10.1176/appi.ps.202000009 · Cited by 27 · see citing works
Dopp, A. R., Hunter, S. B., Godley, M. D., Pham, C., Han, B., Smart, R., Cantor, J., Kilmer, B., Hindmarch, G., González, I. E., et al. (2022) · Implementation Science Communications · doi:10.1186/s43058-022-00298-y · Cited by 27 · see citing works
Self-citationLyon, A. R., Pullmann, M. D., Dorsey, S., Levin, C., Gaias, L. M., Brewer, S. K., Larson, M. F., Corbin, C. M., Davis, C. J., Muse, I., et al. (2021) · Implementation Science · doi:10.1186/s13012-020-01064-1 · Cited by 26 · see citing works
Nevedal, A., Widerquist, M. A. O., Reardon, C. M., Arasim, M. E., Jackson, G. L., White, B. S., Burns, M., Fix, G. M., DeLaughter, K. L., Cutrona, S. L., et al. (2024) · Implementation Science · doi:10.1186/s13012-024-01361-z · Cited by 25 · see citing works
Johnson, E. E., Sterba, K. R., Goodwin, A. J., IV, Warr, E. H., Beeks, R., Zapka, J., & Ford, D. W. (2019) · Annals of the American Thoracic Society · doi:10.1513/annalsats.201810-735oc · Cited by 25 · see citing works
Willging, C. E., Kano, M. A., Green, A. E., Sturm, R., Sklar, M., Davies, S., & Eckstrand, K. (2020) · BMJ Open · doi:10.1136/bmjopen-2019-032787 · Cited by 24 · see citing works
Self-citationZakumumpa, H., Dube, N., Damian, R. S., & Rutebemberwa, E. (2018) · Global Health Research and Policy · doi:10.1186/s41256-018-0079-6 · Cited by 23 · see citing works
Hunter, S. B., Felician, M., Dopp, A. R., Godley, S. H., Pham, C., Bouskill, K., Slaughter, M. E., & Garner, B. R. (2020) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2020.107999 · Cited by 21 · see citing works
SafeCare in Israel: The challenges of implementing an evidence-based program
Oppenheim‐Weller, S., & Zeira, A. (2017) · Children and Youth Services Review · doi:10.1016/j.childyouth.2017.12.031 · Cited by 20 · see citing works
Dopp, A. R., Gilbert, M., Silovsky, J. F., Ringel, J. S., Schmidt, S. R., Funderburk, B. W., Jorgensen, A. G., Powell, B. J., Luke, D. A., Mandell, D. S., et al. (2022) · Implementation Science Communications · doi:10.1186/s43058-021-00234-6 · Cited by 20 · see citing works
Barnett, M. L., Brookman-Frazee, L. I., Yu, S. H., Lind, T., Lui, J. H. L., Timmer, S. G., Boys, D. K., Urquiza, A. J., Innes-Gomberg, D., Quick-Abdullah, D., et al. (2021) · Evidence-Based Practice in Child and Adolescent Mental Health · doi:10.1080/23794925.2020.1855613 · Cited by 19 · see citing works
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Pedroso, R. T., Juhásová, M. B., & Merchán-Hamann, E. (2019) · Interface - Comunicação Saúde Educação · doi:10.1590/interface.170566 · Cited by 19 · see citing works
School nurse perception of asthma care in school-based telehealth
MacGeorge, C. A., King, K. L., Andrews, A. L., Sterba, K. R., Johnson, E. E., Brinton, D. L., Teufel, R. J., Kruis, R. D., & Ford, D. W. (2021) · Journal of Asthma · doi:10.1080/02770903.2021.1904978 · Cited by 16 · see citing works
Hall, T., Honisett, S., Paton, K., Loftus, H., Constable, L. N., & Hiscock, H. (2021) · BMC Psychology · doi:10.1186/s40359-021-00652-0 · Cited by 16 · see citing works
Carcone, A. I., Coyle, K. K., Butame, S. A., Harper, G. W., Aarons, G. A., & Naar, S. (2022) · AIDS and Behavior · doi:10.1007/s10461-022-03735-0 · Cited by 16 · see citing works
Self-citationSquires, A. P. (2019) · Nursing Outlook · doi:10.1016/j.outlook.2019.06.016 · Cited by 15 · see citing works
Nagy, S. M., Butame, S. A., Todd, L. M., Sheffler, J., Henna Budhwani, P., Fernandez, M. I., MacDonell, K. K., & Naar, S. (2021) · AIDS Care · doi:10.1080/09540121.2021.1950604 · Cited by 13 · see citing works
Naar, S., Pennar, A. L., Wang, B., Brogan-Hartlieb, K., & Fortenberry, J. D. (2021) · Health Psychology · doi:10.1037/hea0001071 · Cited by 12 · see citing works
Caton, L., Yuan, M., Louie, D., Gallo, C. G., Abram, K. M., Palinkas, L. A., Brown, C. H., & McGovern, M. P. (2020) · Substance Abuse Treatment Prevention and Policy · doi:10.1186/s13011-020-00326-x · Cited by 9 · see citing works
Improving Management of Infantile Spasms by Adopting Implementation Science
Samanta, D. (2020) · Neuropediatrics · doi:10.1055/s-0040-1716901 · Cited by 9 · see citing works
Dopp, A. R., Hunter, S. B., Godley, M. D., González, I. E., Bongard, M., Han, B., Cantor, J., Hindmarch, G., Lindquist, K. M., Wright, B., et al. (2023) · Implementation Science · doi:10.1186/s13012-023-01305-z · Cited by 7 · see citing works
Self-citationBaumann, A. A., Rodríguez, M. M. D., Wieling, E. A., Parra‐Cardona, J. R., Rains, L. A., & Forgatch, M. S. (2019) · Pilot and Feasibility Studies · doi:10.1186/s40814-019-0476-8 · Cited by 9 · see citing works
Malone, P., & Canavan, J. (2018) · ARAN (University of Galway Research Repository) (Ollscoil na Gaillimhe – University of Galway) · doi:10.13025/20757 · Cited by 8 · see citing works
Stahmer, A. C., Yu, Y., Suhrheinrich, J., Melgarejo, M., & Schetter, P. L. (2024) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-024-06443-x · Cited by 8 · see citing works
An, Q., Sandlund, M., Lundell, S., Kuenen, S., CHASTIN, S. F. M., Helleday, R., Messiha, K., Loisel, Q. E. A., & Wadell, K. (2025) · Design Studies · doi:10.1016/j.destud.2025.101297 · Cited by 8 · see citing works
Mundey, P., Slemaker, A., Dopp, A. R., Beasley, L. O., & Silovsky, J. F. (2020) · The Journal of Behavioral Health Services & Research · doi:10.1007/s11414-020-09726-0 · Cited by 7 · see citing works
Maxwell, C. A., Ehrhart, M. G., Williams, N. J., Moore, T. M., Kendall, P. C., & Beidas, R. S. (2021) · Administration and Policy in Mental Health and Mental Health Services Research · doi:10.1007/s10488-021-01128-4 · Cited by 7 · see citing works
Self-citationWoodward, E. N., Singh, R. S., Ndebele‐Ngwenya, P., Castillo, A. M., Dickson, K. S., & Kirchner, J. E. (2020) · doi:10.21203/rs.3.rs-32704/v2 · Cited by 8 · see citing works
Malone, P., & Canavan, J. (2021) · The British Journal of Social Work · doi:10.1093/bjsw/bcab097 · Cited by 6 · see citing works
Disseminating clinical and fiscal practices across the New York State behavioral healthcare system
Acri, M. C., Fuss, A. A., Quintero, P., Hoagwood, K., McKay, M. M., & Cleek, A. F. (2019) · Social Work in Health Care · doi:10.1080/00981389.2019.1593281 · Cited by 5 · see citing works
A Practical Guide to Incorporating Health Equity Domains in Implementation FrameworksPreprint
Woodward, E. N., Singh, R. S., Ndebele‐Ngwenya, P., Castillo, A. M., Dickson, K. S., & Kirchner, J. E. (2020) · doi:10.21203/rs.3.rs-32704/v1 · Cited by 5 · see citing works
Choy-Brown, M., Hamovitch, E., Bornheimer, L. A., Acri, M. C., & McKay, M. M. (2020) · Children and Youth Services Review · doi:10.1016/j.childyouth.2020.104774 · Cited by 4 · see citing works
Gupta, B., Li, D., Dong, P., & Acri, M. C. (2021) · Journal of Evaluation in Clinical Practice · doi:10.1111/jep.13547 · Cited by 4 · see citing works
Staples, T., Beran-Maryott, G., Brinkerhoff, A., Bradford, M., Ward, R. S., & Thackeray, A. (2021) · Journal of Physical Therapy Education · doi:10.1097/jte.0000000000000182 · Cited by 4 · see citing works
Provider Attitudes, Organizational Readiness for Change, and Uptake of Research Supported Treatment
Bornheimer, L. A., Acri, M. C., Parchment, T. M., & McKay, M. M. (2018) · Research on Social Work Practice · doi:10.1177/1049731518770278 · Cited by 4 · see citing works
Dopp, A. R., North, M. N., Gilbert, M., Ringel, J. S., Silovsky, J. F., Blythe, M., Edwards, D., Schmidt, S. R., & Funderburk, B. W. (2024) · Implementation Research and Practice · doi:10.1177/26334895241249394 · Cited by 3 · see citing works
Lindquist, K. M., Mendon, S. J., Timmins, G. T., Dopp, A. R., & Hunter, S. B. (2024) · JAACAP Open · doi:10.1016/j.jaacop.2024.02.002 · Cited by 3 · see citing works
Fallon, B., Trocmé, N., & Wert, M. V. (2023) · Springer eBooks · doi:10.1007/978-3-031-17299-1_3514 · Cited by 3 · see citing works
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Self-citationAkofio-Sowah, M.-A., & Amekudzi-Kennedy, A. (2016) · Transportation Research Record Journal of the Transportation Research Board · doi:10.3141/2593-01 · Cited by 2 · see citing works
MacDonell, K. K., Dinaj-Koci, V., Koken, J. A., & Naar, S. (2022) · BMC Health Services Research · doi:10.1186/s12913-022-08453-w · Cited by 2 · see citing works
Evaluating SafeCare® in Israel: Benefits for the families
Oppenheim‐Weller, S., Zeira, A., & Mazursky, N. (2020) · Child & Family Social Work · doi:10.1111/cfs.12741 · Cited by 2 · see citing works
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Prevention Systems: Structure and Challenges: Europe as an Example
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Self-citationTelehealth Outreach Program for Child Traumatic Stress: Strategies for Long-Term Sustainability
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Implementation Science: Developing a Common Understanding for Use in Mental Health
Gutner, C. A., & Wells, S. Y. (2021) · Comprehensive Clinical Psychology · doi:10.1016/b978-0-12-818697-8.00086-8
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İnovatif yaklaşım ile kamu personel yönetiminde toplam kalite yönetimi
Kemiksizoğlu, H., & COŞKUN, B. (2024) · Business Economics and Management Research Journal · doi:10.58308/bemarej.1482370
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Lyon, A. R., Pullmann, M. D., Dorsey, S., Levin, C., Gaias, L. M., Brewer, S. K., Larson, M. F., Corbin, C. M., Davis, C. J., Muse, I., et al. (2021) · Figshare · doi:10.6084/m9.figshare.13545238
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Lyon, A. R., Pullmann, M. D., Dorsey, S., Levin, C., Gaias, L. M., Brewer, S. K., Larson, M. F., Corbin, C. M., Davis, C. J., Muse, I., et al. (2021) · Figshare · doi:10.6084/m9.figshare.13545235
- Authors
- Aarons, G. A., Green, A. E., Willging, C. E., Ehrhart, M. G., Roesch, S. C., Hecht, D. B., & Chaffin, M. J.
- Affiliations
- University of California San Diego (US)
- Pacific Institute For Research and Evaluation (US)
- San Diego State University (US)
- University of Oklahoma Health Sciences Center (US)
- Georgia State University (US)
- Corresponding author
- Aarons, Gregory A
- Venue
- Implementation Science
- Published
- 2014-12
- Volume
- 9
- Issue
- 1
- Pages
- 183-183
- ISSN
- 1748-5908 (ISSN-L)
- PMC
- PMC4272775
- OpenAlex
- W2115239664
- Cited by
- 107
- References
- 116
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 15 · 2023: 5 · 2022: 4 · 2021: 31 · 2020: 12 · 2019: 11 · 2018: 5 · 2017: 9 · 2016: 7 · 2015: 2
- FWCI
- 10.83
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Implementation Science (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- eScholarship (California Digital Library) (submittedVersion, cc-by)
- Funders
- National Institute of Mental Health (R01MH072961)
- Topics
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Social Sciences › Decision Sciences › Management Science and Operations Research › Evaluation and Performance Assessment
- Health Sciences › Health Professions › General Health Professions › Health Sciences Research and Education
- Keywords
- implementation sustainability, contracting, stakeholder collaboration, organizational climate, fidelity, employee turnover, implementation leadership, community organizations, institutionalization
- MeSH terms
- Attitude of Health Personnel, Behavior Therapy, Child, Child Abuse, Cooperative Behavior, Delivery of Health Care, Health Policy, Home Care Services, Humans, Interprofessional Relations, Leadership, Prospective Studies, Retrospective Studies, United States, Organizational Culture, Program Evaluation, Organizational Policy, Private Sector, Public Sector, Evidence-Based Medicine
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