Agency and County Characteristics Associated with Sustainability of an Evidence-Based Parenting Program

Introduction: As noted in a recent literature review (Stirman et al., 2012), much remains to be learned about the sustainable use of evidence-based programs in real world settings, particularly from prospective evaluations. Sustainability factors were examined as part of a longitudinal implementation evaluation of the Triple P – Positive Parenting Program system of interventions (Triple P) in two North Carolina counties. Although initial grant funding from the state Division of Public Health was provided to support the scale-up of Triple P, each county and their partners have been responsible for ensuring sustainability.

Methods: Factors associated with sustainability of Triple P in 38 human service agencies were examined, with sustainability defined as whether or not an agency was actively supporting the delivery of Triple P two years into the evaluation. Active agencies (n = 28) were compared to those that had become inactive (n = 10) with regard to several agency characteristics and in relation to county-level implementation support assessed through facilitated semi-structured interview ratings and county service records. Agency climate was assessed by practitioner ratings on a modified implementation climate measure (Klein et al., 2001).

Results: The rate of inactive agencies was almost four times as high in one county (5.4% vs. 21.1%). County characteristics that may be associated with this difference include the strength of the county-level implementation team (88% and 62%, respectively) as well as the amount of dollars provided for Triple P implementation by the state per child in the county ($6.57 vs. $0.61). Across counties, active agencies had significantly more trained practitioners (3.4 vs. 1.3; t = 4.6, p = .000); greater evidence of sustainability plans (3.11 vs. .78 on a 1-6 scale; t = 3.4, p = .002); and more well developed agency leadership and implementation teams (1.39 vs. 1.06 on a 0-2 scale; t = 3.29, p = .002). There was a trend for active agencies to be more likely to have a positive implementation climate (> 3 on 1-4 scale; X² = 3.66, p = .078). Odds ratios indicated that agencies with only 1 practitioner were 14 times more likely to become inactive and those with low climate scores were 4.8 times more likely to become inactive.

Conclusions: Evaluation results indicated the importance of county-level as well as agency-level factors for sustainability of Triple P programs. Findings extend previous work examining implementation variables predicting use of Triple P (Asgary-Eden & Lee, 2012), to sustainability outcomes including those at a county-level that may interact with agency-level factors. This evaluation suggests considerations for effective use of future implementation funding and areas of focus for technical assistance.