Symposia
Dissemination & Implementation Science
Blanche Wright, M.A.
Doctoral Candidate
University of California Los Angeles
Cambridge, Massachusetts
Alex R. Dopp, Ph.D.
Behavioral/Social Scientist
RAND Corporation
Santa Monica, California
Grace Hindmarch, B.S.
Research Assistant
Research Assistant
Santa Monica, California
Isabelle González, PhD
Research Assistant
RAND
Santa Monica, California
Sarah Hunter, PhD
Senior Researcher
RAND Corporation
Santa Monica, CA
Chau Pham, M.S.
Senior Survey Coordinator
RAND
Santa Monica, California
Mark Godley, Ph.D.
Senior Scientist
Chestnut Health Systems
Normal, Illinois
Jonathan Cantor, Ph.D.
Policy Researcher
RAND
Santa Monica, California
Rosanna Smart, Ph.D.
Economist
RAND
Santa Monica, California
Jonathan Purtle, DrPH, MSc
Associate Professor
New York University
New York, New York
Background: Delivery of evidence-based practices (EBPs) in public behavioral health systems is complex, especially during public health emergencies like the COVID-19 pandemic. Collaboration between government agencies and service provider organizations is critical to sustaining EBPs and avoiding service disruption or substitution of less effective practices. This presentation will discuss U.S. states’ efforts to sustain A-CRA (Adolescent Community Reinforcement Approach), a well-established cognitive-behavioral EBP for youth substance use disorders (SUD), during the pandemic.
Method: Data come from a mixed-method study of 19 states that implemented A-CRA before the pandemic with federal grants. Data collection is ongoing through summer 2022, but so far we have conducted qualitative interviews with 16 state SUD agencies and 41 providers (clinicians and supervisors) at organizations that implemented A-CRA. Providers completed an online survey that asked about the pandemic’s effect on sustainment of A-CRA, states’ and organizations’ responses, and general barriers and facilitators to delivering A-CRA. We are using qualitative content analysis and descriptive statistics to explore patterns in states' abilities to sustain A-CRA, and organizing our findings within theories of network governance from public administration.
Results: Of the providers still delivering A-CRA in March 2020, 65% had sustained A-CRA and 35% discontinued as of March 2022. Providers from non-sustaining organizations rated the pandemic as causing greater changes for A-CRA activities (referrals, delivery) and more impact on A-CRA’s sustainability (t = -1.99, p = .03). Preliminary qualitative results suggest sustainment was influenced by communication and leadership at multiple levels within states and provider organizations (i.e., the network of governance for SUD services). The pandemic created similar challenges for sustaining and non-sustaining organizations, but networks with alignment around A-CRA across system levels navigated the challenges more effectively; e.g., COVID-related provider turnover was offset more easily when the state financially supported ongoing A-CRA training.
Conclusions: These results illustrate how to sustain EBPs within service structures and systems during a public health emergency. We will provide actionable disaster preparedness recommendations for states and their provider networks to consider, based on the capacities identified among states that were relatively successful at A-CRA sustainment.