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.
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.
