Planning for Sustainability

Sustainability is the process of ensuring an adaptive and effective system that achieves and maintains desired long-term results (Johnson, K., Hays, C., Center, H., and Daley, C., 2004). In the case of substance abuse prevention, that involves developing prevention systems that promote and support the delivery of effective prevention strategies in order to prevent and reduce substance use, misuse and abuse among whole populations. Ultimately, sustainability is about maintaining positive outcomes in these populations.

In order to plan strategically for and achieve population level reductions in consumption and consequences of alcohol, tobacco and drugs the community must build and strengthen a prevention system. The prevention system — comprised of the community coalition, the agencies, institutions and organizations that carry out the array of strategies to effectively accomplish these changes, and supportive community leaders, stakeholders, and members—must have capacities necessary to plan strategically for, carry out, and sustain prevention interventions with adequate effectiveness, scope, intensity, and reach to achieve targeted reductions in substance using behaviors and related consequences experienced by the community.

Achieving and sustaining desired population-level changes demands these capacities of a community. Building and sustaining these capacities requires thoughtful planning on the part of the coalition and community agencies, institutions, organizations and leaders. This does not happen in a year and may take several cycles of planning and capacity building in order to create a community prevention system capable of such outcomes.

Through focused, intentional collaborative efforts, coalitions can expand the scope of their efforts from work with specific locations or particular groups of people to multiple locations and/or subpopulations and eventually to several settings and entire populations.

At each level of scale, several key capacities are needed to embed the strategy within the community to ensure outcomes achieved are sustained so that the scale of the effort can be increasingly expended and outcomes among larger population numbers achieved. Community agencies, institutions and organizations must work together to:

• strategically leverage and target the system’s existing resources, assets and capacity
• continually expand the community’s ability to effectively respond to changing patterns of substance use consumption and consequences

Capacity is not strengthened without attention and effort. As communities strive toward these types of outcomes, they must intentionally identify the capacities needed by the coalition, the community’s agencies, and the broader community, plan to strengthen those capacities, implement the planned capacity strengthening strategies, and evaluate their effects.

Three Key Sustainability Capacities

Communities must build capacity at three levels to sustain a prevention effort:

• At the Coalition Level
  Capacity of the coalition must be strengthened and expanded to effectively identify and prioritize populations whose substance use consumption is contributing to community problems.
• Among the Community Agencies
  Capacity must be strengthened and expanded among community agencies with a prevention-oriented operating mission to understand and leverage their resources to effectively address factors among populations that contribute to substance use consumption and/or particular consequences.
• Among the Community Members
  Capacity of the community to understand the role and impact of substance use on community problems, and support the coalition efforts to strengthen the community’s prevention system so that it employs strategies (programs, policies, and practices) that will most likely influence population level consumption patterns and reduce resulting problems.

To build these capacities, communities (through their coalitions), must have the ability to:

1. Assure effectiveness and alignment of the prevention system. The coalition, with the community agencies whose services contribute to prevention outcomes assess the prevention strategies (programs, policies, and practices) supported by the community prevention system and assure that:

• Prevention strategies align logically and reach an appropriate number of the targeted population to achieve reductions in substance use behavior targeted through local data-driven needs assessment;
• Agencies whose services contribute to strategic prevention outcomes regularly document the implementation process, including implementation fidelity, adaptations and quality, and use this information for quality improvement;
• Agencies whose services contribute to strategic prevention outcomes regularly document, demonstrate and communicate the accomplishment of intended outcomes.

2. Assure organizations’ ability to support the community prevention system through a coalition strategic planning process in order to achieve targeted changes in substance using behaviors and related consequences at the population level. The coalition must determine that the agencies that are currently implementing the preventive interventions on behalf of the community prevention system have the capacity to sustain the effort. The coalition, as the steward of the community’s prevention system, assures that organizations have the capacities needed to participate fully within the coalition and the community prevention system, including:

• Administrative structures and linkages that support the efforts of the community’s coalition to strategically integrate the skills and capacities of community organizations in order to achieve targeted reductions in substance using behaviors and consequences;
• Administrative polices and procedures that permit community organizations to respond as data indicates to the changes in community conditions related to substance using behaviors and related consequences;
• Administrative structures within prevention focused community organizations that support staff or contracted partners to ensure the community has the expertise needed to plan for and carry out prevention strategies that will achieve population level reductions in substance using behaviors and related consequences;
• The organization has multiple funding sources that support the efforts to achieve population level reductions in substance using behaviors and related consequences.

The coalition must assure that the community is ready to sustain the prevention system and its impacts by working to:

3. Cultivate community support for the prevention system and its outcomes. The community coalition must assure it attains broad community support for its outcomes through:

• Ongoing, dynamic interactive communication with key stakeholders and community leaders that is supportive of the coalition and its strategy;
• Cultivating stakeholders as leaders and champions who support the coalition to strategically address the problems of substance abuse in the community;
• Awareness and support for the coalition and its strategy by community members who integrate concern for substance use issues into their professional, social or personal considerations.

By taking these steps, communities can help to ensure that initial program outcomes are supported and sustained over time.

Reference

Johnson, K., Hays, C., Center, H., and Daley, C. (2004). Building capacity and sustainable prevention innovations: A sustainability planning model. Evaluation and Program Planning, 27, 135–149.

From: SAMHSA/CSAP’s Prevention Fellows Training, Monitoring and Evaluation Workshop: SPF Step 5, August 26-27, 2006. Developed by the Southeast Center for the Application of Prevention Technologies (CAPT)

Developed under the Substance Abuse and Mental Health Services Administration’s (SAMHSA) Center for the Application of Prevention Technologies contract. Reference #HHSS277200800004C. For training and/or technical assistance purposes only.