title: Mixed-method study of a conceptual model of evidence-based intervention sustainment across multiple public-sector service settings.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Psychiatry, University of California, La Jolla, San Diego, CA, USA. gaarons@ucsd.edu.
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Aarons
authors.affiliation: Department of Psychiatry, University of California, La Jolla, San Diego, CA, USA. a4green@ucsd.edu.
authors.forename: Amy E
authors.initials: AE
authors.lastname: Green
authors.affiliation: Pacific Institute for Research and Evaluation, Albuquerque, NM, USA. cwillging@pire.org.
authors.forename: Cathleen E
authors.initials: CE
authors.lastname: Willging
authors.affiliation: Department of Psychology, San Diego State University, San Diego, CA, USA. mehrhart@mail.sdsu.edu.
authors.forename: Mark G
authors.initials: MG
authors.lastname: Ehrhart
authors.affiliation: Department of Psychology, San Diego State University, San Diego, CA, USA. scroesch@sciences.sdsu.edu.
authors.forename: Scott C
authors.initials: SC
authors.lastname: Roesch
authors.affiliation: Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA. debra-hecht@ouhsc.edu.
authors.forename: Debra B
authors.initials: DB
authors.lastname: Hecht
authors.affiliation: School of Public Health, Georgia State University, Atlanta, GA, USA. mchaffin@gsu.edu.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Chaffin
mesh_terms: D001291:Attitude of Health Personnel; D001521:Behavior Therapy / Q000458:organization & administration; D002648:Child; D002649:Child Abuse / Q000517:prevention & control; D003299:Cooperative Behavior; D003695:Delivery of Health Care / Q000592:standards*; D019317:Evidence-Based Medicine; D006291:Health Policy; D006699:Home Care Services / Q000458:organization & administration; D006801:Humans; D007400:Interprofessional Relations; D007857:Leadership; D015279:Organizational Culture; D016134:Organizational Policy; D017149:Private Sector; D015397:Program Evaluation; D011446:Prospective Studies; D017150:Public Sector; D012189:Retrospective Studies; D014481:United States