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

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Aarons, Gregory A, Green, Amy E, Willging, Cathleen E, Ehrhart, Mark G, Roesch, Scott C, Hecht, Debra B, Chaffin, Mark J·2014·Implementation Science

DOI 10.1186/s13012-014-0183-zPMC PMC4272775

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Abstract

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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Figure 1 Sustainment conceptual model based on the Exploration, Preparation, Implementation, Sustainment (EPIS) multilevel conceptual framework (Aarons, Hurlburt, & Horwitz, [[11]]). Note: some constructs may be considered predictors or outcomes dependent on particular hypotheses or research questions.CC BY · PubMed Central

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Additional file 1 of Understanding pathways from implementation to sustainment: a longitudinal, mixed methods analysis of promising practices implemented in the Veterans Health Administration
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) · Figshare · doi:10.6084/m9.figshare.26717053
Additional file 5 of Comparing organization-focused and state-focused financing strategies on provider-level reach of a youth substance use treatment model: a mixed-method study
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Additional file 4 of Comparing organization-focused and state-focused financing strategies on provider-level reach of a youth substance use treatment model: a mixed-method study
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Additional file 3 of Comparing organization-focused and state-focused financing strategies on provider-level reach of a youth substance use treatment model: a mixed-method study
Dopp, A. R., Hunter, S. B., Godley, M. D., González, I., Bongard, M., Han, B., Cantor, J., Hindmarch, G., Lindquist, K. M., Wright, B., et al. (2024) · Figshare · doi:10.6084/m9.figshare.26626366
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Additional file 3 of Protocol for a hybrid type 2 cluster randomized trial of trauma-focused cognitive behavioral therapy and a pragmatic individual-level implementation strategy
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Additional file 3 of The relationship between first-level leadership and inner-context and implementation outcomes in behavioral health: a scoping review
Meza, R. D., Triplett, N. S., Woodard, G. S., Martin, P., Khairuzzaman, A. N., Jamora, G., & Dorsey, S. (2021) · Figshare · doi:10.6084/m9.figshare.14920971
Additional file 2 of Protocol for a hybrid type 2 cluster randomized trial of trauma-focused cognitive behavioral therapy and a pragmatic individual-level implementation strategy
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.13545226
Additional file 1 of The relationship between first-level leadership and inner-context and implementation outcomes in behavioral health: a scoping review
Meza, R. D., Triplett, N. S., Woodard, G. S., Martin, P., Khairuzzaman, A. N., Jamora, G., & Dorsey, S. (2021) · Figshare · doi:10.6084/m9.figshare.14920965
Additional file 1 of Prioritising interventions for preventing mental health problems for children experiencing adversity: a modified nominal group technique Australian consensus study
Hall, T., Honisett, S., Paton, K., Loftus, H., Constable, L. N., & Hiscock, H. (2021) · Figshare · doi:10.6084/m9.figshare.16864921
Additional file 5 of Protocol for a hybrid type 2 cluster randomized trial of trauma-focused cognitive behavioral therapy and a pragmatic individual-level implementation strategy
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
Additional file 1 of Comparing organization-focused and state-focused financing strategies on provider-level reach of a youth substance use treatment model: a mixed-method study
Dopp, A. R., Hunter, S. B., Godley, M. D., González, I., Bongard, M., Han, B., Cantor, J., Hindmarch, G., Lindquist, K. M., Wright, B., et al. (2024) · Figshare · doi:10.6084/m9.figshare.26626360
Self-citation
Additional file 2 of Understanding pathways from implementation to sustainment: a longitudinal, mixed methods analysis of promising practices implemented in the Veterans Health Administration
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) · Figshare · doi:10.6084/m9.figshare.26717056
Additional file 4 of Protocol for a hybrid type 2 cluster randomized trial of trauma-focused cognitive behavioral therapy and a pragmatic individual-level implementation strategy
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
ORCID: Aarons, Gregory A
Green, Amy E
Willging, Cathleen E
Ehrhart, Mark G
Roesch, Scott C
Chaffin, Mark J
Venue: Implementation Science
Publisher: Springer Science and Business Media LLC
Published: 2014-12
Volume: 9
Issue: 1
Pages: 183-183
ISSN: 1748-5908 (ISSN-L)
DOI: 10.1186/s13012-014-0183-z
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
Licence: cc-by
creativecommons.org/licenses/by/4.0 (unspecified)
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 › Public Administration › 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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Mixed-method study of a conceptual model of evidence-based intervention sustainment across multiple public-sector service settings

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