Hunter Sarah B, Han Bing, Slaughter Mary E, Godley Susan H, Garner Bryan R
RAND, 1776 Main Street, Santa Monica, CA, 90407-2138, USA.
RAND, 4570 Fifth Ave., Suite 600, Pittsburgh, PA, 15213, USA.
Implement Sci. 2017 Jun 13;12(1):75. doi: 10.1186/s13012-017-0606-8.
Implementation support models are increasingly being used to enhance the delivery of evidence-based treatments (EBTs) in routine care settings. Little is known about the extent to which these models lead to continued EBT use after implementation support ends. Moreover, few empirical studies longitudinally examine the hypothesized factors associated with long-term psychosocial EBT use (i.e., sustainment). In an effort to address this gap, the current study examined sustainment of an EBT called the Adolescent-Community Reinforcement Approach (A-CRA) following the end of implementation support.
Between 2006 and 2010, the Substance Abuse and Mental Health Services Administration awarded 3 years of A-CRA implementation support to 82 community-based organizations around the USA. The extent to which A-CRA was sustained following grant end and the hypothesized factors associated with EBT sustainment were collected using both retrospective and prospective data. We examined the extent to which 10 core treatment elements of A-CRA were sustained and the associations between the extent of A-CRA sustainment and hypothesized factors using a pattern-mixture longitudinal modeling approach.
Staff from 76 organizations participated in data collection for a 92.86% response rate. On average, about half of the 10 core treatment elements were sustained following the loss of implementation support. Factors that appeared most important to A-CRA sustainment included characteristics that were related to the outer setting (communication, funding, and partnerships), inner setting (political support, organizational capacity, and supervisor turnover rate), implementation support period (number of clinicians and supervisors certified and employed at support end and number of youth served), and staff perceptions of the intervention (implementation difficulty, relative advantage, and perceived success).
Even with multiple years of implementation support, community-based organizations face challenges in sustaining EBT delivery over time. Consistent with implementation theories, multiple factors appear related with EBT sustainment, including the degree of implementation during the initial support period, as well as adequate funding, infrastructure support, and staff support following the end of funding.
实施支持模型越来越多地被用于在常规护理环境中加强循证治疗（EBT）的提供。对于这些模型在实施支持结束后能在多大程度上促使EBT持续使用，人们了解甚少。此外，很少有实证研究纵向考察与长期心理社会EBT使用（即维持）相关的假设因素。为了填补这一空白，本研究在实施支持结束后考察了一种名为青少年社区强化法（A-CRA）的EBT的维持情况。
2006年至2010年期间，物质滥用和精神健康服务管理局向美国各地82个社区组织提供了为期3年的A-CRA实施支持。通过回顾性和前瞻性数据收集了资助结束后A-CRA的维持程度以及与EBT维持相关的假设因素。我们使用模式混合纵向建模方法考察了A-CRA的10个核心治疗要素的维持程度以及A-CRA维持程度与假设因素之间的关联。
76个组织的工作人员参与了数据收集，回复率为92.86%。平均而言，在实施支持结束后，10个核心治疗要素中约有一半得以维持。对A-CRA维持似乎最重要的因素包括与外部环境（沟通、资金和伙伴关系）、内部环境（政治支持、组织能力和主管更替率）、实施支持期（支持结束时认证和雇佣的临床医生和主管数量以及服务的青少年数量）以及工作人员对干预措施的看法（实施难度、相对优势和感知成功率）相关的特征。
即使有多年的实施支持，社区组织在长期维持EBT提供方面仍面临挑战。与实施理论一致，多个因素似乎与EBT维持相关，包括初始支持期的实施程度，以及资金结束后的充足资金、基础设施支持和工作人员支持。
