Predictors of Sustainment of Samhsa Prevention Programs and Initiatives before and after Termination of Federal Funding

Background and Purpose: Sustainment of prevention efforts directed at substance use and mental health problems is one of the greatest, yet least understood challenges of implementation science. In particular, it is unclear whether factors associated with sustainment outcomes while a grantee is being funded are also associated with the same outcomes once the grantee is no longer supported by the original funding source.

Methods: The Sustainment Measurement System, a 50-item instrument grouped into 7 categories of predictors/requirements (funding and financial support, responsiveness to community needs and values, coalitions, partnerships and networks, infrastructure and capacity, leadership, monitoring and evaluation, and positive outcomes), was administered to 109 representatives of 97 grantees funded by 4 SAMHSA grants: Strategic Prevention Framework Partnerships for Success grant [SPF-PFS] (n = 27), Sober Truth on Preventing Underage Drinking [STOP-Act] (n = 43), Garrett Lee Smith Suicide Prevention grant (n=23), and Implementing Evidence-based Prevention Practices in Schools grant (n=6). Sustainability was assessed using four specific outcomes (continuing to operate as described in the original grant, continuing to deliver preventive services to intended population, continuing to deliver evidence-based services, periodically measuring fidelity of services delivered) as well as an average of mean scores on these four outcomes. One-way analysis of variance and Pearson correlations were used to compare sustainment requirements (predictors) and outcomes by funding status (currently funded or no longer funded by SAMHSA grant).

Results: As expected, measures of sustainment outcomes were significantly higher among currently funded grantees than among no longer funded grantees (p < 0.001). Among currently funded grantees, sustainment was significantly associated with responsiveness to community needs and values (r = .61, p < 0.001), coalitions, partnerships and networks (r = .26, p < 0.05), infrastructure and capacity (r = .41, p < 0.001), monitoring and evaluation (r = .25, p < 0.05), and positive outcomes (r = .24, p < 0.05). Among grantees that were no longer funded by their respective SAMHSA grant, sustainment was significantly associated with coalitions, partnerships and networks (r = .84, p < 0.001), alternate sources of funding (r = .80, p < 0.001), leadership (r = .73, p < 0.01), monitoring and evaluation (r = .66, p < 0.05), infrastructure and capacity (r = .62, p < 0.05), and positive outcomes (r = .48, p < 0.05).

Conclusions and Implications: Once the primary source of funding has ended, coalitions, partnerships and networks, having alternate sources of funding, leadership, infrastructure and capacity, monitoring and evaluation, and positive outcomes become more important to sustainment of prevention programs and initiatives while responsiveness to community needs and values becomes less important. These patterns of association between sustainment and outcomes suggest that greater efforts be devoted to developing and supporting these six categories of sustainment requirements from the outset of grantee operations to insure successful sustainment once the primary source of funding has ended.