Measuring Sustainment in Prevention Programs and Initiatives

Sustaining prevention efforts directed at drug and alcohol abuse, HIV, and related mental health problems is currently one of the greatest, yet least understood challenges in the field of implementation science. A large gap in knowledge exists regarding what is meant by the term "sustainment" and what factors predict or even measure sustainability of effective prevention programs and support systems, in continually evolving communities, tribal nations, states, and the federal environment. The proposed research is built on an innovative partnership between the Substance Abuse and Mental Health Services Administration (SAMHSA) and the NIDA-funded Center for Prevention Implementation Methodology (Ce-PIM) for Drug Abuse and Sex Risk Behavior, whose aim is to advance implementation practice through scientific research. SAMHSA supports four different grant programs targeting substance abuse prevention, suicide prevention, and prevention practices in schools, each with a specific set of goals and objectives and each with different prevention approaches to be sustained once support from SAMHSA is no longer available. An examination of all four grant programs simultaneously provides an opportunity to determine what is meant by the term sustainment and identify and support both the unique requirements for improving sustainability for each program as well as for developing a generalizable framework comprised of core components of sustainability across diverse prevention approaches. Based on an analysis of qualitative and quantitative data of eight grantees supported by these four programs, we propose developing a flexible measurement system for sustainability, with both general and specific components that can bring precision to monitoring sustainment of infrastructure, activities and outcomes for each prevention approach. We then propose transforming this measurement system into a format that can be used to evaluate and improve the likelihood of achieving sustainment of a grantee's prevention efforts. To achieve these goals, we propose to:1) Identify core components and their interrelationships across time for sustainability of prevention programs and their support infrastructures; 2) Design a measurement system for monitoring and providing feedback regarding sustainment within four of SAMHSA's prevention-related grant programs, and 3) Pilot test the predictability of this multilevel measurement system across the four SAMHSA-funded programs and the feasibility and acceptability of a checklist to evaluate and improve sustainment likelihood.