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PSMG: Implementation Methods Series - Lawrence Palinkas

Conceptualizing and measuring sustainability of prevention programs and initiatives

Lawrence Palinkas, Ph.D.
University of Southern California

Sustainment of prevention efforts directed at substance use and mental health problems is one of the greatest, yet least understood challenges of implementation science.  A large knowledge gap exists regarding the meaning of the term “sustainment” and what factors predict or measure sustainment of effective prevention programs and support systems. Specifically, it is unclear whether sustainment is an outcome of implementation as described by Proctor and colleagues1, whether it reflects a (final) stage in the process of implementation, or whether it is both process and outcome of implementation.  This presentation describes an effort to design and evaluate a Sustainment Measurement System (SMS), based on interviews with 45 representatives of 10 grantees within 4 SAMHSA programs (Strategic Prevention Framework – State Initiative Grants, Sober Truth on Preventing Underage Drinking [STOP-Act], Garrett Lee Smith Suicide Prevention Program, and Prevention Practices in Schools). Data collection consisted of a semi-structured interview to identify experiences with implementation and sustainment barriers and facilitators; free list exercise to elicit participant conceptions of the word “sustainment” and what it will take to sustain their programs; and a checklist of Consolidated Framework for Implementation Research (CFIR) elements to identify which are important for sustainment.  A draft SMS will be introduced, along with a preliminary conceptual model to explain the sustainment of community-wide prevention programs that are designed for and implemented in community settings, and a qualitative comparative analysis (QCA) of CFIR domains to identify necessary and sufficient conditions for sustainment.