Making Implementation Last: Understanding the Sustainability of an Evidence-based Treatment

Abstract

Although advances have been made in facilitating the implementation of evidence-based treatments, little is known about the most effective way to sustain their use over long periods of time. Prior systematic reviews and research have suggested that organizational characteristics and training methods may be strategies that support sustainability, yet this has remained relatively unstudied in the field of behavioral health. The current study examined the sustainability of Parent-Child Interaction Therapy following a statewide implementation trial testing three training methods. Participants included 100 clinicians and 50 administrators from 50 organizations across Pennsylvania. Multi-level path analysis was utilized to examine the role of organizational barriers and training on sustainability. Clinicians and administrators reported high levels of sustainability at 24-months (12-months post-training) in the current study. Several organizational variables, including training exposure and utilization and resources at baseline and following training were associated with greater sustainability. The cascading model training condition was also related to being more likely to sustain the use of Parent-Child Interaction Therapy. Possible mechanism of change, through increased organizational resources, were also identified. Implications for training and the broader field of implementation science are discussed.