(Withdrawn) Program Sustainment of Nonprofit and Government Organizations Addressing Adolescent Mental Health Needs

Introduction: Across the United States, adolescent depressive symptoms such as persistent feelings of hopelessness or sadness and suicidal behavior have drastically increased in recent years. Moreover, in 2019, 15% of students reported ever using illicit drugs, with Hispanic male students reporting slightly higher drug use. These rates are also estimated to have increased since the COVID-19 pandemic due to a combination of the public health crisis, social isolation, and economic recession. Several organizations and agencies have sought to prevent these behavioral and mental health outcomes, including government agencies and non-profit organizations. Sustainment of prevention efforts directed at substance use and mental health problems is one of the greatest, yet least understood challenges of implementation science. It is unclear which specific organizational domains are predictive of sustainment of crucial services. Furthermore, sustainment may also operate differently depending on the organization, as governmental agencies, and nonprofit organizations (NPOs) may vary in structure and operations.

Methods: The Sustainment Measurement System, a 35-item instrument grouped into seven categories of sustainability predictors (e.g., funding and financial support; staff capability) and one category of sustainment outcomes, was administered to 186 representatives of 145 grantees funded by seven SAMHSA grant programs. Linear growth curve models were used to examine the trajectory of sustainment over three waves of data. Number of board members, employees, volunteers, and years of operation, as well as nonprofit status were added to the models as covariates to assess their influence on independent sustainability-sustainment associations.

Results: Growth curve models revealed statistically significant associations between program sustainment and the following predictors: community needs & values (β = 0.44, p < 0.001); coalitions, partnerships & networks (β = 0.24, p < 0.000); evaluation, feedback, & evidence of positive outcomes (β = 0.10, p = 0.02); and infrastructure & organizational capacity (β = -0.11, p = 0.04). None of the organizational characteristics (e.g., years of operation, board size) were statistically significant.

Conclusions: Community needs & values; coalitions, partnerships & networks; evaluation, feedback, & evidence of positive outcomes; infrastructure & organizational capacity seem to become more important to sustainment of prevention programs and initiatives led by both nonprofit and government organizations. However, NPO status was not a significant predictor of sustainment. This suggests that though NPOs and governmental agencies may differ from one another in structure and operations, their distinctions may blur in other regards. Program sustainment is crucial to addressing the mental health needs of vulnerable youth and may be more achievable by first understanding which elements are most linked to sustainment. Greater efforts should be devoted to developing and supporting these categories of sustainment requirements from the outset of grantee operations to ensure successful sustainment once the primary source of funding has ended.