Building capacity and sustainable prevention innovations: a sustainability planning model

Abstract

This article presents an informed definition of sustainability and an associated planning model for sustaining innovations (pertinent to both infrastructure and interventions) within organizational, community, and state systems. The planning model stems from a systematic review of the literature and from concepts derived from a series of ‘think tanks’ made up of key substance abuse prevention professionals. The model assumes a five-step process (i.e. assessment, development, implementation, evaluation, and reassessment/modification) and addresses factors known to inhibit efforts to sustain an innovation. One set of factors concerns the capacity of prevention systems to support sustainable innovations. The other pertains to the extent to which a particular innovation is sustainable. A sustainability action strategy is presented that includes goals with corresponding sets of objectives, actions, and results that determine the extent of readiness to sustain an innovation. Sustainability tools to assist in implementing the planning model are illustrated, and next steps for the model are discussed. This planning model provides a conceptual and practical understanding of sustainability that can lead to further investigation.

Introduction

Over the past three decades, considerable resources have been spent in the United States and other countries to implement and validate innovative prevention programs and strategies. For example, science-based substance abuse prevention innovations that include school-based programs (Tobler & Stratton, 1997), family-based programs (Johnson et al., 1998, Kumpfer, 1997), and environmental strategies (Holder, 2001, Gruenewald et al., 2001) are now available for replication. Other health promotion programs have attained prominence in addressing threats concerning cancer (Kaluzny, Schenck, & Ricketts, 1986), heart disease (Bracht et al., 1994), mental health (Glaser and Backer, 1980, Murphy, 1981), and oral health issues (Silversin, Coombs, & Drolette, 1980). Also, increasingly available for implementation are growing numbers of violence prevention programs (Derzon, Wilson, & Cunningham, 1999).

Often designed as demonstrations or community trials, prevention innovations have focused primarily on successful implementation without creating as well assurances of ‘life of innovations’ after extramural funding has ended (Akerlund, 2000, Goodman et al., 1993, Green, 1989, Shediec-Rizkallah and Bone, 1998, Vaughn et al., 2000). Given this problem, there is a general consensus that sustainability guidance is essential (Backer, 2000, Goodman and Steckler, 1989). In response, this article presents a planning model for sustaining prevention innovations designed for organizational, community, and state prevention systems.

The impetus for developing this sustainability planning model comes from a critical need in the substance abuse prevention field, and it was precipitated by a federal initiative, the State Incentive Grant (SIG) program funded by the Center for Substance Abuse Prevention (CSAP). From 1997 to 2002, a series of three-year grants totaling $9 million each have been given to a large majority of the states to fund these goals: (1) promote systems change in state and local prevention systems and (2) implement and evaluate science-based prevention programs and/or strategies (CSAP, 2002). Although states agreed to a variety of CSAP conditions, one of which was to consider sustaining effective systemic changes and prevention interventions after federal funding ended, only a limited number of planning strategies and tools are yet available for grantees to use in making sustainability decisions. The sustainability model presented here stems from a systematic literature synthesis and information that emerged from a series of ‘think tanks’ involving key substance abuse prevention professionals who are affiliated with CSAPs Southeast Center for the Application of Prevention Technology (CAPT). Although this model has been developed in the substance abuse prevention field, we believe it can be generalized to other prevention areas.

First, we discuss the literature about sustainability and related terms. Second, we present a prevention-focused sustainability-planning model that highlights key factors relating to sustaining innovations and how to deal with them. Third, we discuss lessons learned and future steps for the model. This planning model is being presented to provide the impetus for further empirical investigation relating to the sustainability of prevention innovations.