Comparing Two Federal Financing Strategies on Treatment Penetration and Sustainment

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PROJECT SUMMARY/ABSTRACT Sustained, widespread availability of evidence-based practices (EBPs) is essential to addressing the public health and societal impacts of adolescent substance use disorders (SUD), as recognized by the NIDA priority (Strategic Objective 3.4) to investigate strategies for effective and sustainable implementation of EBPs. There remains a particularly significant need to identify effective financing strategies, which secure and direct financial resources to support essential activities for EBP implementation and sustainment, and overcome cost-related barriers to the availability of effective adolescent SUD treatments. The proposed R01 project will compare the effects of two SAMHSA grant mechanisms (i.e., financing strategies), which supported the adoption of an EBP for adolescent SUD, the Adolescent Community Reinforcement Approach, through either organization-focused or state-focused granting of funds. The Exploration-Preparation-Implementation- Sustainment framework will guide our study aims, hypotheses, and selection of measures. The interdisciplinary project team – consisting of experts in implementation science, adolescent SUD treatment, health economics, public policy, and statistics – will employ a longitudinal, mixed method (i.e., quantitative surveys and qualitative interviews, document review, and focus groups), quasi-experimental design to compare the grant types’ outcomes and examine theoretically-informed mediators and moderators. Aim 1 will examine penetration of the Adolescent Community Reinforcement Approach among eligible clinicians (i.e., proportion certified with adequate fidelity) and clients (i.e., proportion receiving the treatment) at the end of SAMHSA funding; and Aim 2 will examine sustainment of the treatment model, using a 10-element composite measure of treatment delivery and supervision activities, up to 5 years post-funding. Our approach aligns with a previous grant (R01AA021217), enabling integration of the data we collect from state-focused grant recipients (85 organizations in 19 states) with previously collected data on implementation and sustainment outcomes among organization-focused grant recipients (84 organizations in 26 states). We will also evaluate non-equivalent dependent variables (i.e., outcomes that are not expected to change as a result of grant type) to control for key observable, time-varying cohort effects within our quasi-experimental study design. Finally, Aim 3 will use comparative case study methods to identify policy implications for promoting EBP penetration and sustainability through integration of our diverse quantitative and qualitative measures. The proposed research will have immediate, practical implications for behavioral health administrators, policymakers, implementation experts, and the public with new knowledge that can directly inform financing strategies to support large-scale, sustained EBP delivery in behavioral health – while simultaneously advancing the emergent implementation science field through use of novel methods to study financing strategies and sustainment outcomes.