Identifying Necessary and Sufficient Conditions for Long-Term Sustainability of the Strengthening Families Program

Introduction

The long-term, enduring success of substance use prevention efforts is dependent upon programs’ abilities to sustain efforts beyond initial seed grant funding. A clear understanding of the conditions necessary and sufficient for successful sustainability is critically important to realizing the public health impact of programs. Existing sustainability research typically does not capture the real-world conditions that are assets and barriers to sustainability, particularly at the community and organizational level.

Methods

One state Extension system in the Pacific Northwest has trained over 800 Strengthening Families Program facilitators (SFP; an evidence-based, family-focused, youth substance use prevention program) who have implemented more than 500 programs under natural conditions, reaching over 10,000 parents and youth over the past 15 years. This study uses mixed-methods to explore the community, organizational, and program factors associated with sustainability in a subset of these communities. Fifty nine facilitators completed an online survey, including the Program Sustainability Assessment Tool (PSAT; Luke et al., 2014) and reported their sustainability level. Twenty also participated in semi-structured interviews. Qualitative Comparative Analysis (QCA), was used to identify sets of conditions (as measured by the PSAT and in the themes that emerged in the qualitative interviews) that are necessary, sufficient, or both to attain sustainability success.

Results

Bivariate correlations showed that all but one PSAT scale were positively related with sustainability: environmental support (r = .69, p < .0001), funding stability (r = .62, p < .0001), partnerships (r = .61, p < .0001), organizational capacity (r = .61, p < .0001), program evaluation (r = .40, p < .01), communication (r = .62, p < .0001), and strategic planning (r = .45, p < .01). QCA analyses revealed that 11 of the 13 high sustainability sites reported at or above the mean on the PSAT environmental support and organizational capacity scales suggesting that having a supportive internal and external climate for the program, in combination with strong internal support and resources needed to effectively manage the program were conditions consistently present in those sites with high sustainability. These themes were validated by the interviews.

Conclusions

This study contributes to the emerging research base for understanding the factors that promote long-term sustainability of community-based prevention programs. The use of an innovative case-centered technique, QCA, demonstrated that although many factors may play a role in promoting sustainability, environmental support and organizational capacity appear to be key ingredients to successful long-term implementation of SFP.