Predicting evidence-based treatment sustainment: results from a longitudinal study of the Adolescent-Community Reinforcement Approach

Hunter, Sarah B.; Han, Bing; Slaughter, Mary E.; Godley, Susan H.; Garner, Bryan R.

doi:10.1186/s13012-017-0606-8

Cited by 56Health Policy Implementation ScienceSubstance Abuse Treatment and OutcomesPsychotherapy Techniques and Applications

Predicting evidence-based treatment sustainment: results from a longitudinal study of the Adolescent-Community Reinforcement Approach

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Hunter, Sarah B., Han, Bing, Slaughter, Mary E., Godley, Susan H., Garner, Bryan R.·2017·Implementation Science

DOI 10.1186/s13012-017-0606-8PMC PMC5470280

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Abstract

BACKGROUND: Implementation support models are increasingly being used to enhance the delivery of evidence-based treatments (EBTs) in routine care settings. Little is known about the extent to which these models lead to continued EBT use after implementation support ends. Moreover, few empirical studies longitudinally examine the hypothesized factors associated with long-term psychosocial EBT use (i.e., sustainment). In an effort to address this gap, the current study examined sustainment of an EBT called the Adolescent-Community Reinforcement Approach (A-CRA) following the end of implementation support. METHODS: Between 2006 and 2010, the Substance Abuse and Mental Health Services Administration awarded 3 years of A-CRA implementation support to 82 community-based organizations around the USA. The extent to which A-CRA was sustained following grant end and the hypothesized factors associated with EBT sustainment were collected using both retrospective and prospective data. We examined the extent to which 10 core treatment elements of A-CRA were sustained and the associations between the extent of A-CRA sustainment and hypothesized factors using a pattern-mixture longitudinal modeling approach. RESULTS: Staff from 76 organizations participated in data collection for a 92.86% response rate. On average, about half of the 10 core treatment elements were sustained following the loss of implementation support. Factors that appeared most important to A-CRA sustainment included characteristics that were related to the outer setting (communication, funding, and partnerships), inner setting (political support, organizational capacity, and supervisor turnover rate), implementation support period (number of clinicians and supervisors certified and employed at support end and number of youth served), and staff perceptions of the intervention (implementation difficulty, relative advantage, and perceived success). CONCLUSIONS: Even with multiple years of implementation support, community-based organizations face challenges in sustaining EBT delivery over time. Consistent with implementation theories, multiple factors appear related with EBT sustainment, including the degree of implementation during the initial support period, as well as adequate funding, infrastructure support, and staff support following the end of funding.

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Findings are consistent with previous research using the PSAT showing higher levels of environmental support are reported by programs with greater sustainment success.
“Our findings are consistent with previous research using the PSAT showing higher levels of environmental support are reported by programs with greater sustainment success [31, 32, 42].”
From Using qualitative comparative analysis to uncover multiple pathways to program sustainment: implications for community-based youth substance misuse prevention (2022) · cites this paper as [32]

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Additional file 1 of Influence of participation in a quality improvement collaborative on staff perceptions of organizational sustainability
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Additional file 2 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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Self-citation

Authors: Hunter, S. B., Han, B., Slaughter, M. E., Godley, S. H., & Garner, B. R.
Affiliations: RAND Corporation (US)
Chestnut Health Systems (US)
RTI International (US)
Corresponding author: Hunter, Sarah B.
ORCID: Hunter, Sarah B.
Han, Bing
Slaughter, Mary E.
Garner, Bryan R.
Venue: Implementation Science
Publisher: Springer Science and Business Media LLC
Published: 2017-06-13
Volume: 12
Issue: 1
Pages: 75-75
ISSN: 1748-5908 (ISSN-L)
DOI: 10.1186/s13012-017-0606-8
PMC: PMC5470280
OpenAlex: W2625164072
Cited by: 56
References: 50
Citations by year: 2026: 4 · 2025: 3 · 2024: 18 · 2023: 4 · 2022: 6 · 2021: 9 · 2020: 5 · 2019: 2 · 2018: 4 · 2017: 1
FWCI: 5.30
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by
creativecommons.org/licenses/by/4.0/ (tdm)
creativecommons.org/licenses/by/4.0/ (vor)
Locations: Implementation Science (publishedVersion, cc-by)
Europe PMC (PubMed Central) (publishedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders: National Institute on Alcohol Abuse and Alcoholism (R01 AA021217)
Topics: Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Keywords: evidence-based treatment, Adolescent Community Reinforcement Approach, implementation support, community organizations, addiction treatment, implementation theory, organizational capacity, employee perceptions
MeSH terms: Adolescent, Community Health Services, Humans, Longitudinal Studies, Reinforcement, Psychology, United States, United States Substance Abuse and Mental Health Services Administration, Program Evaluation, Evidence-Based Medicine, Substance-Related Disorders

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Predicting evidence-based treatment sustainment: results from a longitudinal study of the Adolescent-Community Reinforcement Approach

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