title: The Roles of System and Organizational Leadership in System-Wide Evidence-Based Intervention Sustainment: A Mixed-Method Study.
abstract: If evidence-based interventions (EBIs) are not sustained, investments are wasted and public health impact is limited. Leadership has been suggested as a key determinant of implementation and sustainment; however, little empirical work has examined this factor. This mixed-methods study framed using the Exploration, Preparation, Implementation, Sustainment (EPIS) conceptual framework examines leadership in both the outer service system context and inner organizational context in eleven system-wide implementations of the same EBI across two U.S. states and 87 counties. Quantitative data at the outer context (i.e., system) and inner context (i.e., team) levels demonstrated that leadership predicted future sustainment and differentiated between sites with full, partial, or no sustainment. In the outer context positive sustainment leadership was characterized as establishing a project's mission and vision, early and continued planning for sustainment, realistic project plans, and having alternative strategies for project survival. Inner context frontline transformational leadership predicted sustainment while passive-avoidant leadership predicted non-sustainment. Qualitative results found that sustainment was associated with outer context leadership characterized by engagement in ongoing supportive EBI championing, marketing to stakeholders; persevering in these activities; taking action to institutionalize the EBI with funding, contracting, and system improvement plans; and fostering ongoing collaboration between stakeholders at state and county, and community stakeholder levels. For frontline leadership the most important activities included championing the EBI and providing practical support for service providers. There was both convergence and expansion that identified unique contributions of the quantitative and qualitative methods. Greater attention to leadership in both the outer system and inner organizational contexts is warranted to enhance EBI implementation and sustainment.
authors.affiliation: Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive (8012), La Jolla, CA, 92093-0812, USA. gaarons@ucsd.edu.|Child and Adolescent Services Research Center, San Diego, CA, 92123, USA. gaarons@ucsd.edu.
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Aarons
authors.affiliation: Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive (8012), La Jolla, CA, 92093-0812, USA.|Child and Adolescent Services Research Center, San Diego, CA, 92123, USA.
authors.forename: Amy E
authors.initials: AE
authors.lastname: Green
authors.affiliation: Pacific Institute for Research and Evaluation, Behavioral Health Research Center of the Southwest, Albuquerque, NM, 87102, USA.|Department of Anthropology, 1, University of New Mexico, Albuquerque, NM, 87131, USA.
authors.forename: Elise
authors.initials: E
authors.lastname: Trott
authors.affiliation: Pacific Institute for Research and Evaluation, Behavioral Health Research Center of the Southwest, Albuquerque, NM, 87102, USA.|Department of Anthropology, 1, University of New Mexico, Albuquerque, NM, 87131, USA.
authors.forename: Cathleen E
authors.initials: CE
authors.lastname: Willging
authors.affiliation: Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive (8012), La Jolla, CA, 92093-0812, USA.|Child and Adolescent Services Research Center, San Diego, CA, 92123, USA.
authors.forename: Elisa M
authors.initials: EM
authors.lastname: Torres
authors.affiliation: Department of Psychology, San Diego State University, 5500 Campanile Dr, San Diego, CA, 92182-4611, USA.
authors.forename: Mark G
authors.initials: MG
authors.lastname: Ehrhart
authors.affiliation: Child and Adolescent Services Research Center, San Diego, CA, 92123, USA.|Department of Psychology, San Diego State University, 5500 Campanile Dr, San Diego, CA, 92182-4611, USA.
authors.forename: Scott C
authors.initials: SC
authors.lastname: Roesch
mesh_terms: D001291:Attitude of Health Personnel; D002140:California; D017028:Caregivers / Q000193:education*; D002649:Child Abuse / Q000517:prevention & control*; D002662:Child Health Services; D002669:Child Welfare; D002675:Child, Preschool; D055317:Evidence-Based Practice; D017144:Focus Groups; D006282:Health Personnel; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007857:Leadership; D008605:Mental Health Services; D015397:Program Evaluation; D011634:Public Health; D036301:Qualitative Research
keywords: EPIS; Evidence-based practice; Healthcare; Leadership; Mixed-methods; Sustainability