Navigating Funding Cliffs: An Exploration of the Dynamic Contextual Factors That Influence Evidence-Based Practice Sustainment

Abstract

Objective

Contextual factors exert dynamic influences on sustainment of evidence-based practice (EBP) after grant funding ends (ie, funding cliffs), but how these factors change over time remains poorly understood. Exploring the factors that affect EBP sustainment trajectories can help explain how community-based treatment organizations navigate funding cliffs.

Method

The study sample comprised 51 community-based treatment organizations drawn from national cohorts that completed federal grants to implement the Adolescent Community Reinforcement Approach (A-CRA), a youth substance use EBP. Interviews were conducted with clinical staff (N = 129) across 2 or 3 annual waves. Interviews focused on staff perspectives about A-CRA sustainment. Based on interview field notes, a longitudinal thematic analysis was conducted to identify influences on organizational sustainment trajectories (ie, pivotal moments, transitions, driving forces, and slow burn processes).

Results

The end of grant funding triggered numerous sustainment challenges. Pivotal moment events, such as receiving additional funding for A-CRA, helped mitigate the consequences of funding cliffs. Transitions, such as staff turnover, generally impeded sustainment, as organizations had to reinvest in A-CRA-trained staff. Other factors exerted effects that were either directly connected to A-CRA (driving forces), such as committed leadership that fostered staff buy-in, or were more indirectly related (slow burns), such as client population characteristics that made A-CRA delivery challenging.

Conclusion

These results illustrate how interrelated processes influence EBP sustainment trajectories. Although organizations may exhibit a pattern of supports for sustainment of EBP, these factors can change over time and do not guarantee future sustainment. These findings also can inform strategies for strengthening EBP sustainment.

Plain language summary

This study interviewed providers from 51 treatment organizations on steps taken to ensure sustainment, or continuing use, of their evidence-based substance use treatment programs. Findings showed that no single factor guarantees or negates future sustainment – rather, it was a complex process that unfolds over time and follows a variety of pathways. For example, “pivotal moment” events like receiving additional funding were often key to sustaining treatment over time; whereas “transitions” like having providers leave the organization were threats to sustainment unless resources were available to involve additional providers. These findings suggest opportunities for policy and program supports.