The U.S. Preventive Services Task Force recommends that clinicians adopt universal alcohol screening and brief intervention as a routine preventive service for adults, and efforts are underway to support its widespread dissemination. The likelihood that healthcare systems will sustain this change, once implemented, is under-reported in the literature. This article identifies factors that were important to postimplementation sustainability of an evidence-based practice change to address alcohol misuse that was piloted within three diverse primary care organizations. The Centers for Disease Control and Prevention funded three academic teams to pilot and evaluate implementation of alcohol screening and brief intervention within multiclinic healthcare systems in their respective regions. Following the completion of the pilots, teams used the Program Sustainability Assessment Tool to retrospectively describe and compare differences across eight sustainability domains, identify strengths and potential threats to sustainability, and make recommendations for improvement. Health systems varied across all domains, with greatest differences noted for Program Evaluation, Strategic Planning, and Funding Stability. Lack of funding to sustain practice change, or data monitoring to promote fit and fidelity, was an indication of diminished Organizational Capacity in systems that discontinued the service after the pilot. Early assessment of sustainability factors may identify potential threats that could be addressed prior to, or during implementation to enhance Organizational Capacity. Although this study provides a retrospective assessment conducted by external academic teams, it identifies factors that may be relevant for translating evidence-based behavioral interventions in a way that assures that they are sustained within healthcare systems.

Using a web-based self-report survey, this study examined the characteristics of individuals who worked directly with youth in out-of-school time programs. Specifically, it examined the relationships among intent to continue working in the youth development field and youth program staffs' experience, training, educational background, and selfreported competency in implementing the features of positive developmental settings for youth (Eccles and Gootman, Community programs to promote youth development, 2002). To accomplish this, we also developed a self-report youth worker competency measure and present its psychometric properties. Results suggested that intent to continue working in the youth development field is higher for youth workers who reported higher overall jobrelated competency, received professional development training, reported life experiences similar to the youth with whom they worked, learned aspects of their job from more experienced staff, had adequate supervision and support, and worked in programs where staff were more involved in program decision-making. Results are discussed in terms of the value of training and professional development in retaining frontline youth workers.Keywords Staff retention Á Staff competency Á Frontline youth workers As attention to the value of promoting positive development in youth increases, greater emphasis is being placed on the role of organized community-based out-of-school time programs in that process. Participating in organized activities fosters and supports personal growth among participating youth by providing them an opportunity to interact with peers and adults in their communities (Hirsch 2005;Perkins et al. 2003). As such, the goals of community-based youth programs include not only ameliorating problems associated with various risk conditions and behaviors (e.g., drinking, drugs, delinquency), but also preparing youth to meet other life challenges and make decisions that promote their own

The following study, funded by the National Institute of Drug Abuse (NIDA), utilized the Addiction Belief Inventory (ABI; Luke, Ribisl, Walton, & Davidson, 2002) to examine addiction attitudes in a national sample of U.S. college/university faculty teaching addiction-specific courses (n=215). Results suggest that addiction educators view substance abuse as a coping mechanism rather than a moral failure, and are ambivalent about calling substance abuse or addiction a disease. Most do not support individual efficacy toward recovery, the ability to control use, or social use after treatment. Modifiers of addiction educator attitudes include level of college education; teaching experience; licensure/certification, and whether the educator is an addiction researcher. Study implications, limitations, and directions for future research are discussed.

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Background: Evidence-based strategies exist to train healthcare professionals to ask their patients and clients about alcohol use, and are successful. Implementation of these strategies utilizing a system-level approach has not been conducted nationwide. This case study reports on the success of academic partnerships with national health professional organizations to increase adoption of evidence-based strategies to prevent alcohol-exposed pregnancies. Methods: Authors reviewed and summarized multi-level strategies created as part of the developmental phase of this project in order to report successes and challenges. We applied the three principles of reflection, sense-making, and reciprocal learning, as identified in the practice change literature, to synthesize our experience. Results: There were five primary lessons learned as a result of this work: Development of technology-based training websites requires significant time to design, implement, and test; project ‘mission-drift’ is inevitable, but not necessarily unwelcome; time and effort is required to create and sustain functioning workgroups when there are different organizational cultures; and changing real-world practice is hard to do, yet changing the conversation on screening and brief intervention is possible. Conclusions: Use of multi-level strategies within an academic–professional organization model was successful in promoting awareness and education of healthcare professionals in the prevention of alcohol-exposed pregnancies.