Purpose. In 1985, congress inserted a “women's set-aside” requirement in the Substance Abuse Prevention and Treatment (SAPT) Block Grant to stimulate the states to increase women-centered policies and services. Block grants are a major way that Federal dollars are transferred to states. Prior to this, states varied substantially in how they addressed alcohol and other drug (AOD) issues for women with some states doing very little. The women's set-aside established women as a priority and in 1992, also defined basic elements that must be included in states' programming for women. This paper uses a dissemination of innovation framework, defining approaches for women as innovations in a field designed and implemented initially by and for men. The paper delineates 1) strategies states employed to implement “set-aside” requirements and how these changed over time, 2) issues faced during implementation by policy makers and administrators at three levels: Federal, state and local; 3) innovative activities states reported; and 4) indicators of impact on resources for women.

Methods. We analyzed both qualitative and quantitative data sources by state and by gender, using content analysis of 3 years of funding applications and 8 years of questionnaires in which states reported on their approaches and activities in comparable ways. At least one interview was conducted in each state with the person most knowledgeable about approaches for women in the administrative office responsible for administering the SAPT Block grant. These interviews were coded using both inductive and deductive approaches. Data were synthesized and categorized using in vivo analyses and several types of triangulation.

Results: Data indicate that the “women's set-aside” stimulated new efforts and mechanisms, especially in states that had not attended specifically to women's issues before the requirement. Approaches are categorized into three major clusters: those that increase the state office's capacity to provide leadership on issues relevant for women and girls, those that increase access to treatment by either reducing barriers or strengthening approaches to outreach and engagement, and those that stimulate, assist, and monitor local programs to improve their services. We depict relationships between Federal incentives and resources, state strategies, and influence at the local level. Innovations are presented in state practices and in creating incentives, standards, and advocacy mechanisms at multiple levels.

Implications: Results are discussed from a dissemination of innovation perspective, emphasizing what is needed when implementing an innovation requires many changes and challenges existing assumptions and practices. Data emphasize the importance of champions, efforts to integrate block grant requirements with existing practices, creating incentives and monitoring mechanisms, and other ways to stimulate both creativity and compliance with particular criteria. We highlight some special issues that arise from the focus on women, especially in relation to challenges to the status quo, and propose some ways that power needs more attention in the literature on dissemination of innovation.