IMPLEMENT AN EVIDENCE-BASED PROGRAM

SECTION

5.3

ADDITIONAL RESOURCE

In the context of program implementation, sustainability can be defined on the individual, organizational, or community levels.

  • Individual level — Maintenance of program benefits for individual participants after the program ends.

  • Organizational level — Maintaining program activities within an organization and making sure program goals and approaches adapt to changing needs over time. This is sometimes referred to as institutionalization.

  • Community level — Increasing the capacity of a community to develop and implement program activities.

All three levels of sustainability are important and each is particularly relevant depending on your circumstance. Individual level sustainability is important to examine during evaluation research. Data on individual level sustainability contributes to the evidence base of a program. An organization might choose to implement one program over another due to the individual level sustainability demonstrated in evaluation studies. Community level sustainability is especially important to consider if a community coalition participated in the selection or implementation process. If you are in a position to influence policy then you would also be interested in this level of sustainability.

 

Most organizations planning and implementing programs will be mainly concerned with organizational level sustainability. This level pertains to the abilities of individual organizations to maintain implementation of their programs in the face of changes in funding, resource availability, and audience characteristics.

 

Before implementing strategies to increase sustainability, organizations must determine if their program should be sustained. In general, programs that produce positive outcomes should be sustained. Sometimes programs will not produce positive outcomes or will produce few positive outcomes in proportion to the resources invested in them. In these latter situations, organizations must determine whether or not to sustain their programs.

 

If you believe a program failed to produce positive outcomes due to a distinct variable that will not be repeated (such as a community-wide disaster or significant staff turnover that occurred during implementation), then you may choose to sustain the program with the expectation that positive outcomes will pick up now that the variable has passed. If, on the other hand, you believe the program was unsuccessful due to it being a mismatch with your organization or the audience, then it would be unwise to continue investing in the program. If the program did produce positive outcomes but they were small in proportion to the resources invested into it, then consider searching for a program that targets a similar outcome. You may be able to identify and implement a similar program that is less costly, less time consuming, and/or requires fewer staff members.

 

Strategies to increase sustainability

 

Because settings and audiences vary so widely, there are no hard-and-fast strategies that can be recommended for application in all situations. Instead, various strategies should be applied if relevant to your organization, program, and audience. Be sure to pay close attention to fidelity when selecting strategies to increase sustainability so that you do not jeopardize program outcomes.

  • Identify alternative funding sources — Consider every possible source of future funding (see Obtaining Funding for ideas). Learn more about these sources, including what funding opportunities are available and what reporting requirements they have for funded organizations.

  • Involve key stakeholders — Determine which stakeholders are crucial to the ongoing implementation of your organization’s program. Do you need referrals from healthcare providers? Engage physician groups and nurses. Do you need access to city-owned park and recreation facilities? Engage staff at the parks and recreation department. Other important stakeholders may be members of local and state government, leaders of local community-based or faith-based organizations, senior center staff, hospital staff, or members of volunteer organizations.

  • Form partnerships — Partnering with other agencies allows you to share resources (staff, facilities, equipment, communication channels, etc.), which can decrease implementation costs considerably. Partnerships also give you access to a broader pool of potential participants, which means greater likelihood of maintaining enrollment.

  • Align program services with organizational goals — In general, organizational leadership will be more likely to reassign or find additional funding for a program if it is congruent with the organization’s mission.

  • Select affordable supplemental services — If you provide services to participants that are above and beyond those required for program fidelity, select services that are affordable. For example, it would be quite costly to provide nicotine replacement therapies to participants in a smoking cessation program. However, if your state has a program that provides these for free to participants enrolled in smoking cessation programs, then you could provide the service of assisting participants in applying to receive the therapies from the state.

  • Change staff composition — While program fidelity may require that certain implementation roles be filled by individuals with particular credentials or experience, there may be flexibility in who can fill some other positions. Consider using nonpaid staff (e.g., volunteers, interns) or lay leaders who are compensated with small stipends.