Measuring Coalition Capacity to Foster Program Sustainment

DRAFT: Specific Aims 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 (Chambers, 2011). This challenge is most apparent when a funding stream ends and many if not most of the prevention programs and infrastructure supports end as well. 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. This research proposal is built on an innovative partnership between the Substance Abuse and Mental Health Services Administration (SAMHSA), the major federal agency responsible for delivering substance abuse prevention and mental health promotion programs in this country, 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. As a major step in this partnership we are proposing the development and feasibility testing of a measurement system to support improved monitoring and feedback for sustainment of evidence-based prevention practices, programs and initiatives. 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 generalizeable framework comprised of core components of sustainability across diverse prevention approaches. Based on an examination of 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 the structures and processes for implementing and sustaining each prevention approach. We then propose transforming this measurement system into a checklist 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. Using ethnographic interviews, administrative data and network analysis of two grantees within each of the four SAMHSA programs described below, we will identify relevant sustainability components, structures and functioning for agencies/organizations that host prevention programs, community coalitions, and tribal and state prevention service systems. This will enable us to determine whether or not a program has been sustained, what features of the grantee organization and its external environment were critical to supporting that sustainment, and which of these features are common across all four programs. 2) Design a measurement system for monitoring and providing feedback regarding sustainment within four of SAMHSA’s prevention-related grant programs. Building on the results of Aim 1, we will determine whether the information n