title: System-Level Influences on the Sustainability of a Cognitive Therapy Program in a Community Behavioral Health Network.
abstract: OBJECTIVE
  The purpose of this study was to examine influences on the sustainability of a program to implement an evidence-based psychotherapy in a mental health system.
  
  
  METHODS
  Interviews with program administrators, training consultants, agency administrators, and supervisors (N=24), along with summaries of program evaluation data and program documentation, were analyzed with a directed content-analytic approach.
  
  
  RESULTS
  Findings suggested a number of interconnected and interacting influences on sustainability, including alignment with emerging sociopolitical influences and system and organizational priorities; program-level adaptation and evolution; intervention flexibility; strong communication, collaboration, planning, and support; and perceived benefit. These individual factors appeared to mutually influence one another and contribute to the degree of program sustainability achieved at the system level. Although most influences were positive, financial planning and support emerged as potentially both facilitator and barrier, and evaluation of benefits at the patient level remained a challenge.
  
  
  CONCLUSIONS
  Several factors appeared to contribute to the sustainability of a psychosocial intervention in a large urban mental health system and warrant further investigation. Understanding interconnections between multiple individual facilitators and barriers appears critical to advancing understanding of sustainability in dynamic systems and adds to emerging recommendations for other implementation efforts. In particular, implications of the findings include the importance of implementation strategies, such as long-term planning, coalition building, clarifying roles and expectations, planned adaptation, evaluation, diversification of financing strategies, and incentivizing implementation.
authors.affiliation: Dr. Stirman and Ms. Gamarra are with the Women's Health Sciences Division, U.S. Department of Veterans Affairs (VA) National Center for PTSD, Boston (e-mail: sws@bu.edu ). Dr. Stirman is also with the Department of Psychiatry, Boston University. Dr. Matza is with the Lesbian, Gay, Bisexual, and Transgender Program, Office of Patient Care Services, U.S. Department of Veterans Affairs Central Office, Washington, D.C. Ms. Toder, Dr. Beck, Dr. Crits-Christoph, and Dr. Creed are with the Department of Psychiatry, University of Pennsylvania, Philadelphia. Ms. Xhezo, Dr. Evans, and Dr. Hurford are with the Philadelphia Department of Behavioral Health and Intellectual disAbility Services, Philadelphia.
authors.forename: Shannon Wiltsey
authors.initials: SW
authors.lastname: Stirman
authors.affiliation: Dr. Stirman and Ms. Gamarra are with the Women's Health Sciences Division, U.S. Department of Veterans Affairs (VA) National Center for PTSD, Boston (e-mail: sws@bu.edu ). Dr. Stirman is also with the Department of Psychiatry, Boston University. Dr. Matza is with the Lesbian, Gay, Bisexual, and Transgender Program, Office of Patient Care Services, U.S. Department of Veterans Affairs Central Office, Washington, D.C. Ms. Toder, Dr. Beck, Dr. Crits-Christoph, and Dr. Creed are with the Department of Psychiatry, University of Pennsylvania, Philadelphia. Ms. Xhezo, Dr. Evans, and Dr. Hurford are with the Philadelphia Department of Behavioral Health and Intellectual disAbility Services, Philadelphia.
authors.forename: Alexis
authors.initials: A
authors.lastname: Matza
authors.affiliation: Dr. Stirman and Ms. Gamarra are with the Women's Health Sciences Division, U.S. Department of Veterans Affairs (VA) National Center for PTSD, Boston (e-mail: sws@bu.edu ). Dr. Stirman is also with the Department of Psychiatry, Boston University. Dr. Matza is with the Lesbian, Gay, Bisexual, and Transgender Program, Office of Patient Care Services, U.S. Department of Veterans Affairs Central Office, Washington, D.C. Ms. Toder, Dr. Beck, Dr. Crits-Christoph, and Dr. Creed are with the Department of Psychiatry, University of Pennsylvania, Philadelphia. Ms. Xhezo, Dr. Evans, and Dr. Hurford are with the Philadelphia Department of Behavioral Health and Intellectual disAbility Services, Philadelphia.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Gamarra
authors.affiliation: Dr. Stirman and Ms. Gamarra are with the Women's Health Sciences Division, U.S. Department of Veterans Affairs (VA) National Center for PTSD, Boston (e-mail: sws@bu.edu ). Dr. Stirman is also with the Department of Psychiatry, Boston University. Dr. Matza is with the Lesbian, Gay, Bisexual, and Transgender Program, Office of Patient Care Services, U.S. Department of Veterans Affairs Central Office, Washington, D.C. Ms. Toder, Dr. Beck, Dr. Crits-Christoph, and Dr. Creed are with the Department of Psychiatry, University of Pennsylvania, Philadelphia. Ms. Xhezo, Dr. Evans, and Dr. Hurford are with the Philadelphia Department of Behavioral Health and Intellectual disAbility Services, Philadelphia.
authors.forename: Katherine
authors.initials: K
authors.lastname: Toder
authors.affiliation: Dr. Stirman and Ms. Gamarra are with the Women's Health Sciences Division, U.S. Department of Veterans Affairs (VA) National Center for PTSD, Boston (e-mail: sws@bu.edu ). Dr. Stirman is also with the Department of Psychiatry, Boston University. Dr. Matza is with the Lesbian, Gay, Bisexual, and Transgender Program, Office of Patient Care Services, U.S. Department of Veterans Affairs Central Office, Washington, D.C. Ms. Toder, Dr. Beck, Dr. Crits-Christoph, and Dr. Creed are with the Department of Psychiatry, University of Pennsylvania, Philadelphia. Ms. Xhezo, Dr. Evans, and Dr. Hurford are with the Philadelphia Department of Behavioral Health and Intellectual disAbility Services, Philadelphia.
authors.forename: Regina
authors.initials: R
authors.lastname: Xhezo
authors.affiliation: Dr. Stirman and Ms. Gamarra are with the Women's Health Sciences Division, U.S. Department of Veterans Affairs (VA) National Center for PTSD, Boston (e-mail: sws@bu.edu ). Dr. Stirman is also with the Department of Psychiatry, Boston University. Dr. Matza is with the Lesbian, Gay, Bisexual, and Transgender Program, Office of Patient Care Services, U.S. Department of Veterans Affairs Central Office, Washington, D.C. Ms. Toder, Dr. Beck, Dr. Crits-Christoph, and Dr. Creed are with the Department of Psychiatry, University of Pennsylvania, Philadelphia. Ms. Xhezo, Dr. Evans, and Dr. Hurford are with the Philadelphia Department of Behavioral Health and Intellectual disAbility Services, Philadelphia.
authors.forename: Arthur C
authors.initials: AC
authors.lastname: Evans
authors.affiliation: Dr. Stirman and Ms. Gamarra are with the Women's Health Sciences Division, U.S. Department of Veterans Affairs (VA) National Center for PTSD, Boston (e-mail: sws@bu.edu ). Dr. Stirman is also with the Department of Psychiatry, Boston University. Dr. Matza is with the Lesbian, Gay, Bisexual, and Transgender Program, Office of Patient Care Services, U.S. Department of Veterans Affairs Central Office, Washington, D.C. Ms. Toder, Dr. Beck, Dr. Crits-Christoph, and Dr. Creed are with the Department of Psychiatry, University of Pennsylvania, Philadelphia. Ms. Xhezo, Dr. Evans, and Dr. Hurford are with the Philadelphia Department of Behavioral Health and Intellectual disAbility Services, Philadelphia.
authors.forename: Matthew
authors.initials: M
authors.lastname: Hurford
authors.affiliation: Dr. Stirman and Ms. Gamarra are with the Women's Health Sciences Division, U.S. Department of Veterans Affairs (VA) National Center for PTSD, Boston (e-mail: sws@bu.edu ). Dr. Stirman is also with the Department of Psychiatry, Boston University. Dr. Matza is with the Lesbian, Gay, Bisexual, and Transgender Program, Office of Patient Care Services, U.S. Department of Veterans Affairs Central Office, Washington, D.C. Ms. Toder, Dr. Beck, Dr. Crits-Christoph, and Dr. Creed are with the Department of Psychiatry, University of Pennsylvania, Philadelphia. Ms. Xhezo, Dr. Evans, and Dr. Hurford are with the Philadelphia Department of Behavioral Health and Intellectual disAbility Services, Philadelphia.
authors.forename: Aaron T
authors.initials: AT
authors.lastname: Beck
authors.affiliation: Dr. Stirman and Ms. Gamarra are with the Women's Health Sciences Division, U.S. Department of Veterans Affairs (VA) National Center for PTSD, Boston (e-mail: sws@bu.edu ). Dr. Stirman is also with the Department of Psychiatry, Boston University. Dr. Matza is with the Lesbian, Gay, Bisexual, and Transgender Program, Office of Patient Care Services, U.S. Department of Veterans Affairs Central Office, Washington, D.C. Ms. Toder, Dr. Beck, Dr. Crits-Christoph, and Dr. Creed are with the Department of Psychiatry, University of Pennsylvania, Philadelphia. Ms. Xhezo, Dr. Evans, and Dr. Hurford are with the Philadelphia Department of Behavioral Health and Intellectual disAbility Services, Philadelphia.
authors.forename: Paul
authors.initials: P
authors.lastname: Crits-Christoph
authors.affiliation: Dr. Stirman and Ms. Gamarra are with the Women's Health Sciences Division, U.S. Department of Veterans Affairs (VA) National Center for PTSD, Boston (e-mail: sws@bu.edu ). Dr. Stirman is also with the Department of Psychiatry, Boston University. Dr. Matza is with the Lesbian, Gay, Bisexual, and Transgender Program, Office of Patient Care Services, U.S. Department of Veterans Affairs Central Office, Washington, D.C. Ms. Toder, Dr. Beck, Dr. Crits-Christoph, and Dr. Creed are with the Department of Psychiatry, University of Pennsylvania, Philadelphia. Ms. Xhezo, Dr. Evans, and Dr. Hurford are with the Philadelphia Department of Behavioral Health and Intellectual disAbility Services, Philadelphia.
authors.forename: Torrey
authors.initials: T
authors.lastname: Creed
mesh_terms: D015928:Cognitive Behavioral Therapy / Q000191:economics*; D019058:Community Networks; D003299:Cooperative Behavior; D019317:Evidence-Based Medicine; D005260:Female; D006282:Health Personnel; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D010414:Pennsylvania; D015397:Program Evaluation / Q000191:economics*
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