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A significant concern with the implementation of any EBI is sustainability. Considerable energy and resources are often dedicated to the start-up of a program. Does that investment have a short-lived return? Or have resources been invested in a program that continues to have a lasting impact on the community? Sustainability is a common challenge for any evidence-based prevention or intervention program, particularly when grant funding ends and the program must access other means of support.

The past 15 years have seen considerable strides in the dissemination, implementation, and support of EBIs across Pennsylvania. The Commonwealth expanded from a single FFT site in 1999 to 8 FFT sites, 47 MST teams, and 4 MTFC sites as of July 1, 2012. The pattern of sustainability has been different for each of the three EBIs.

Overall Number of Teams and Sites (New/Sustained)

Overall Number of Teams and Sites

Multisystemic Therapy:
Over the past decade MST has seen a steady increase in the number of teams in Pennsylvania. MST has an overall sustainability rate of 80% (47 of 59 teams). MST has generally enjoyed a high level of buy-in from county probation offices. In addition, many teams were established after M.A. funding began in 2005.

Functional Family Therapy:
FFT has gone through periods of growth, followed by program closures. When FFT Inc. implemented a more formal process for clinical oversight and monitoring of program fidelity, several sites that had been established using PCCD grants earlier in the decade closed. Later, sites struggled with the transition from county funding and PCCD grant funding to M.A., which culminated in nine site closures between 2008 and 2011. While the EPISCenter provided active technical assistance to several of these sites in 2010 and 2011, many were unable to overcome challenges with low referrals, inadequate revenue, county buy-in, and/or competition from other programs (most often Family-Based Mental Health Services or MST). FFT has an overall sustainability rate of 30% (8 of 27 sites).

On a positive note, many of the remaining sites have resolved significant challenges over the past 2 ½ years ago. The EPISCenter provided technical assistance to several FFT sites, developed FFT-related resources to help providers advocate for their programs, and shared the concerns of FFT providers with state partners. Some sites were successful in obtaining higher rates from their BH-MCO, increasing the rate of referrals through collaboration with their counties and outreach to other potential referral sources, and developing a mechanism for immediate authorization from the BH-MCO (therefore reducing cost to the county).

Multidimensional Treatment Foster Care:
Historically, MTFC sites have struggled to sustain in Pennsylvania. A spike in the number of programs in 2008 and 2009, related to programs beginning under the final PCCD grants for evidence-based interventions, was followed by a period of numerous closures. Providers have been unable to generate enough referrals to keep their programs open and to recruit enough treatment parents to place the youth who are referred. The overall sustainability rate for MTFC in Pennsylvania is 36% (4 of 11). While one new site was established in July 2012, two sites are in the process of closing.

Download Sustainability (Written in December 2012)


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