It has been more than a decade since the release of the Institute of Medicine's landmark report (IOM, 1998) that described the need to """"""""bridge the gap"""""""" between research and practice. Since then, efforts to disseminate evidence-based treatments (EBTs) to usual care delivery settings have been launched, however little is known about the long-term effectiveness of these efforts. For example, since 2006, the Center for Substance Abuse Treatment (CSAT) funded 81 substance use treatment sites across the country to deliver an EBT as part of their treatment regime. Once this initiative ends, the deliver of the EBT is largely left up to the local sites to support. Without attention to ensuring sustainability, these efforts to support EBT implementation may not meet their full potential. The current proposal is to examine the sustainment of an EBT in these settings. We propose the following aims: 1) Characterize levels of EBT implementation longitudinally for programs that received CSAT funding to implement A- CRA by: a. Identifying aspects of the EBT that are sustained, innovations in EBT implementation, and candidate facilitators and barriers to implementation;b. Characterizing the trajectory of implementation quality among the 81 programs over time. We hypothesize that substantial changes will occur after government funding ends. Specifically, we hypothesize that programs will demonstrate decreases in sustainment over time and that there will be differences among programs in change over time;and 2) empirically evaluate factors that predict the degree of EBT sustainment. We hypothesize that the extent to which the EBT is sustained will be associated with environmental (i.e., reimbursement for services) and organizational factors (i.e., presence of trained supervisors and clinicians at the end of the funding phase) after controlling for a number of program-specific (e.g., size) factors. The proposed research is highly significant. Gaining a better understanding of the factors that influence the sustainability of EBT delivery may lead to more effective dissemination strategies and ultimately improve the quality of care being delivered in community based addiction treatment settings.

Public Health Relevance

Providing addiction treatment may lead to a significant public health impact, but the treatment needs to be implemented with quality to reap these benefits. The proposed project fulfills a critical knowledge gap by providing results about the sustainment of treatments funded through recent government efforts to improve evidence-based treatment delivery in local settings.

National Institute of Health (NIH)
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Research Project (R01)
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Special Emphasis Panel (ZRG1-HDM-J (90))
Program Officer
Lowman, Cherry
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Rand Corporation
Santa Monica
United States
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Hunter, Sarah B; Han, Bing; Slaughter, Mary E et al. (2017) Predicting evidence-based treatment sustainment: results from a longitudinal study of the Adolescent-Community Reinforcement Approach. Implement Sci 12:75
Huang, Wenjing; Hunter, Sarah B; Ayer, Lynsay et al. (2017) Measuring sustainment of an evidence based treatment for adolescent substance use. J Subst Abuse Treat 83:55-61
Garner, Bryan R; Hunter, Sarah B; Slaughter, Mary E et al. (2017) Factors associated with an evidence-based measure of implementation for the Adolescent Community Reinforcement Approach. Drug Alcohol Depend 180:144-150
Garner, Bryan R; Hunter, Sarah B; Funk, Rodney R et al. (2016) Toward Evidence-Based Measures of Implementation: Examining the Relationship Between Implementation Outcomes and Client Outcomes. J Subst Abuse Treat 67:15-21
Hunter, Sarah B; Schwartz, Robert P; Friedmann, Peter D (2016) Introduction to the Special Issue on the Studies on the Implementation of Integrated Models of Alcohol, Tobacco, and/or Drug Use Interventions and Medical Care. J Subst Abuse Treat 60:1-5
Hunter, Sarah B; Han, Bing; Slaughter, Mary E et al. (2015) Associations between implementation characteristics and evidence-based practice sustainment: a study of the Adolescent Community Reinforcement Approach. Implement Sci 10:173
Hunter, Sarah B; Ayer, Lynsay; Han, Bing et al. (2014) Examining the sustainment of the Adolescent-Community Reinforcement Approach in community addiction treatment settings: protocol for a longitudinal mixed method study. Implement Sci 9:104