HIV Insight: Understanding the Sustainability of Implementing HIV Services in Criminal Justice Settings

Background

In the growing field of implementation science, sustainability is a critical component of the implementation process of moving evidence-based treatments to regular practice. This paper is intended to extend our understanding of factors that influence the sustainability of HIV services in correctional settings following an organization-level intervention designed to implement improvements in preventing, detecting, or treating HIV for persons under correctional supervision.

Methods

Using semi-structured interviews to elicit perceptions from the principal researcher and executive sponsor at each of nine participating sites, this study explores the variations in the sustainability of HIV services in these criminal justice settings following the experimental implementation intervention.

Results

In six of the nine sites, changes in HIV services implemented as a result of the organizational intervention were sustained six to nine months following the end of project implementation. Organizational endorsement at multiple levels is likely the principal factor that facilitates sustainability.

Conclusions

The factors that result in the sustainability of changes to health services in correctional organizations include elements internal and external to the organization. Implementation strategies, such as the change team model strategy used in this study, are also sustainable and can be used to identify other changes that could be made, or improve other aspects of service delivery.

...Despite efforts being made to reduce the gap between evidence-based practices and routine practices (e.g.,Proctor et al. 2009; Greenhalgh et al. 2004), there remains a lack of literature regarding successful sustainability and dissemination of organizational changes in health-related settings (e.g., Goisman et al. 1999; McHugh and Barlow 2010; Stewart and Chambless 2007). Limited research has identified the factors that influence sustainability including characteristics of the intervention, organizational factors, and contextual factors (e.g., Scheirer and Dearing 2011). More research is needed, particularly regarding the factors that influence the implementation of health services in a criminal justice setting. Anchored in the HIV-STIC protocol, this study shed light on what elements were sustained and factors that facilitated or hindered the sustainability of the intervention across nine research sites, using principal investigators and lead agency administrators as key informants.

Six out of nine research sites reported that the implemented services had been either codified at the site or institutionalized into agency (i.e., Department of Correction) policy at the site, or scaled up to a broader context in terms of extending the services or practices to other facilities. In addition, participants reported a peripheral element of sustainability—improvements in the relationship between different agencies providing HIV services. Inter-organizational collaboration and communication, which are opportunities for learning and information sharing in the pursuit of service enhancement, are believed to promote implementation processes and therefore quality of services provided in organizations. The relationships established during the course of implementation, either as a focus area of the intervention (e.g., linkage to treatment) or an inevitable component peripheral to implementation is a critical element of sustainability. Additionally, inter-organizational relationships developed during the HIV-STIC study strengthened the partnership between multiple organizations and facilitated the communication of organizational values and missions, which in turn led to alignment of practices and eventually better quality of care...

Full article at: http://goo.gl/VJg4d1