In their 2004 research paper, “Building Capacity and Sustainable Prevention Innovations: A Sustainability Planning Model” (PDF | 235 KB), Johnson et al. define sustainability as the process of ensuring an adaptive and effective system that achieves and maintains desired long-term results. In the case of substance misuse prevention, the process involves developing systems that promote and support the delivery of effective prevention strategies in order to prevent and reduce substance use disorders among populations. Ultimately, sustainability is about maintaining positive outcomes in these populations.
To plan strategically for and achieve population-level reductions in consumption and consequences of alcohol, tobacco, and other drugs, the community must build and strengthen a prevention system. The prevention system is comprised of the community coalition, the agencies, institutions, and organizations that carry out the array of strategies to effectively accomplish these changes. Community leaders, stakeholders, and other individuals play a supporting role. The system and its stakeholders must have the capacities necessary to plan strategically for, carry out, and sustain prevention interventions with adequate effectiveness, scope, intensity, and reach to achieve targeted outcomes in substance misuse 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 specific populations 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:
- 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
- Evaluate their effects
Three Key Sustainability Capacities
Communities must build capacity at three levels to sustain a prevention effort:
- At the coalition level. The capacity of the coalition must be strengthened and expanded to effectively identify and prioritize populations whose substance use is contributing to community problems.
- Among community agencies. The capacity of community agencies must be strengthened and expanded with a prevention-oriented operating mission. This will help agencies to understand and leverage their resources to effectively address factors among populations that contribute to substance use issues and/or particular consequences.
- Among community members. The capacity of the community to understand the role and impact of substance use on community problems is critical to prevention planning efforts. Community members must support 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:
- Ensure effectiveness and alignment of the prevention system. The coalition, with the community agencies whose services contribute to prevention outcomes, must assess the prevention strategies (programs, policies, and practices) supported by the community prevention system and ensure that:
- Prevention strategies align logically and reach an appropriate number of the targeted population to achieve reductions in substance use behavior targeted based on a 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
- Contributing agencies regularly document, demonstrate, and communicate the accomplishment of intended outcomes
- Ensure organizations’ ability to support the community prevention system through a coalition strategic planning process that helps achieve targeted changes in substance use behaviors and related consequences at the population level. The coalition must determine that the agencies that are 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 use behaviors and consequences
- Administrative policies and procedures that permit community organizations to respond as data indicates to the changes in community conditions related to substance use 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 use behaviors and related consequences
- The organization has multiple funding sources that support efforts to achieve population-level reductions in substance use behaviors and related consequences
The coalition must assure that the community can sustain the prevention system and its impacts by working to:
- 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 supports 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.
The SAMHSA Center for Substance Abuse Prevention (CSAP) Prevention Fellows Training, Monitoring and Evaluation Workshop: SPF Step 5, August 26-27, 2006