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Cultural Spaces in Indigenous Communities Program. National Action Plan to End Gender-Based Violence. Sport for Social Development in Indigenous Communities. Actions to address anti-Indigenous racism in health systems.

Addressing Racism and Discrimination in Canada's Health Systems. Co-development of Distinctions-Based Indigenous Health Legislation. Improving access to safe, clean drinking water in First Nation communities.

Co-development of Infrastructure Plans. Indigenous community infrastructure fund. Indigenous Shelter and Transitional Housing Initiative. Indigenous Early Learning and Child Care Framework. Executive Summary of Agreement-in-Principle on Long-Term Reform.

Reducing the number of Indigenous children in care via the An Act respecting First Nations, Inuit and Métis children, youth and families. Comprehensive Violence Prevention Strategy. Journal of Primary Prevention. ISSN X. National Institutes of Health NIH.

Retrieved Lisa; Ryan, Jean A. David Psychology and Educational Practice. Administration and Policy in Mental Health and Mental Health Services Research. Child Development. School Mental Health Services in the United States, SAMHSA's National Clearinghouse for Alcohol and Drug Information NCADI.

Journal of Research in Crime and Delinquency. Journal of Community Psychology. Aggression and Violent Behavior. Substance Use and Misuse. Legal Issues Drug Treatment Court — CAMH 1 Figure 9. There are many DTC across Canada. A Gladue report is a written document that weaves together your story with information from interviews with family, Elders, and community members.

It can also include relevant documentation to support the judge in making an appropriate decision. Gladue Practices in the Provinces and Territories — Including names of the courts cited by the participants and their locations 3.

Each Province has supports for this: Alberta Manitoba New Brunswick Ontario. For more information: Elizabeth Fry Society — Canada 4.

works with people who have come into conflict with the law, reviews, evaluates and advocates for changes in the criminal justice process, engages in public education on matters relating to criminal law and its application promotes crime prevention through community and social development activities.

For more information: John Howard Society — Canada 5. Reflect on these changes: Reflect for a moment on how these changes impacted the community you work with? What is the value of expanding, evolving or creating changes to agencies?

Can you think of any programs that you know of that have expanded, evolved, changed or closed? What are some examples? How could you help others understand the changes? What training is involved in updating skills as a service provider? Pieces to be aware of: Accessibility is the practice of making your programs, websites, support, activities usable by as many people as possible.

It is not just about people with disabilities, but the practice of making programs accessible to everyone, online, in person, using mobile devices, or those with slow network connections or no network connections Stigma — Refers to the discrediting, devaluing, and shaming of a person because of characteristics or attributes they possess which leads to reluctance to seek help or treatment.

Can affect individuals, families and communities. It can be influenced by cultural and contextual value systems that differ over time and across contexts.

language — is it offered in many languages. Three types of languages are written, oral and nonverbal. culture awareness — able to support cultural awareness — being aware the cultural awareness is the understanding that our own culture differs from one individual and group to the next, and specifically from our target language.

Understanding this enables us to communicate more effectively, beyond words and grammar, by understanding their culture. Our awareness of these GAPS can make the difference between communicating and not communicating.

Amadeusz — supports young people who are incarcerated to create positive change in their lives through education, community programs and supports Oasis — Addiction Recovery and Employment Services Street Voices — is a social enterprise and media platform with an online directory that provides access to free and subsidized services to empower street-involved and at-risk youth Abrar — Trauma and Mental Health Services — dedicated to providing affordable, trauma informed, art based, and culturally sensitive mental support for diverse newcomers and immigrant populations.

References: Figure 9. Drug Treatment Court Services. Gladue Practices in the Provinces and Territories. html Wilfred Laurier. Gladue Principles: Indigenous Peoples and the Canadian Criminal Justice System. html CAEFS. Homepage — CAEFS. CAEFS — Just Another WordPress Site.

The John Howard Society of Canada. shtml — Grand Valley Institute for Women Home — Walls to bridges. Walls to Bridges. Home Amadeusz.

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Public Safety Canada's National Crime Prevention Strategy NCPS provides funding to strategically selected projects that contribute to preventing and reducing crime in Canada and to increasing knowledge about what works in crime prevention.

In order to achieve its goals, the NCPS identifies specific priorities for project funding. Building on past successes and lessons learned, the NCPS aims to deliver concrete results in local communities by funding and evaluating interventions to prevent and reduce offending among those most at-risk, especially:.

Within these populations, the NCPS will also target specific priority crime issues such as drug-related crime, youth gangs and gun violence. The Communities at Risk: Security Infrastructure Program SIP provides time-limited funding to enhance the security infrastructure of communities targeted by hate-motivated crime.

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Indigenous Screen Office funding programs. Indigenous documentary heritage initiatives. Cultural Spaces in Indigenous Communities Program. Please enable JavaScript to improve your experience. The Initiative is a multi-departmental, government — community partnership to find long term solutions to the problem of violence against those most at risk in our society — women, children, youth, older persons, persons with disabilities, Indigenous women and children and other people who are vulnerable to violence because of their ethnicity, sexual orientation or economic status.

The Violence Prevention Initiative is coordinated by the Office for the Status of Women.

However, what is to be sustained differs from one program to the next [ 5 , 6 ]. For instance, with respect to the community coalitions supporting drug and suicide prevention activities, some definitions of sustainment focus on the continued existence of the coalition itself while others focus on the activities and impacts of the coalition [ 7 ].

Moreover, sustainability, defined as the capacity to maintain EBP components [ 8 ], is increasingly being viewed as a dynamic process with shifting outcomes that represents increased likelihood that the program or infrastructure will continue, while sustainment refers to the continued operation of a program or initiative, often relating to the time after initial funding has ended [ 8 , 9 ].

In recent years, there has been a proliferation of frameworks that focus specifically on sustainability [ 3 , 4 , 7 , 8 , 9 ]. However, despite the growing consensus as to how sustainability should be defined [ 3 , 4 , 9 ], the underdeveloped state of measurement of sustainment poses one of the most serious methodological challenges to understanding and facilitating sustainability of evidence-based practices and programs [ 9 , 10 , 11 ].

Some instruments like the Stages of Implementation Completion SIC [ 12 ] have been developed to measure the implementation outcomes of a specific intervention [ 13 ]. The SIC is an 8-stage assessment tool developed as part of a large-scale randomized implementation trial that contrasted two methods of implementing an EBP for youth with serious behavioral problems in the juvenile justice and child welfare systems.

Within each of the eight stages, subactivities are operationalized and completion of activities are monitored, along with the length of time taken to complete these activities.

Competency in program delivery stage 8 is considered to be a measure of program sustainment [ 13 ], although continued use of the EBP once competency has been attained is not assessed.

Data on the validity and reliability of the SIC to assess sustainment outcomes is lacking. Other instruments like the Program Sustainability Assessment Tool PSAT [ 14 , 15 , 16 ], Sustained Implementation Support Scale SISS [ 17 ], and Program Sustainability Index PSI [ 18 ], take a broader ecological approach to sustainability and are used primarily to assess capacity and to plan for sustainability by measuring determinants or factors that influence sustainability.

The SISS is a item scale composed of five subscales Program Benefits, Program Burdens, Workplace Support, Workplace Cohesion, and Leadership Style and designed to measure capacity to maintain implementation of components of an EBP for parent training.

The PSI is a item scale reflecting 7 sustainability elements leadership competence, effective collaboration, understanding the community, demonstrating program results, strategic funding, staff involvement and integration, and program responsivity.

However, none of these instruments assess both sustainability determinants and sustainment outcomes. One of the reasons for developing a valid and reliable measure of sustainment is to provide a means of conducting an audit and providing feedback to organizations engaged in implementing innovative and evidence-based programs and practices.

While monitoring and feedback are recognized as important for prevention [ 19 , 20 ], much of the relevant science on feedback in health has involved improvement in clinical performance [ 21 , 22 , 23 , 24 , 25 , 26 , 27 ]. This includes clinical supervision and use of technology like electronic dashboards in measurement-based quality improvement MBQI strategies that monitor patient behavior and clinician activity [ 28 , 29 , 30 ], while prevention has a more limited history of using computational technologies for monitoring [ 31 , 32 , 33 , 34 ].

Such feedback offers the clinician a better understanding of whether they are on course to achieve a successful outcome or need to alter their treatment in order to improve the likelihood of a successful outcome.

MBQI strategies also hold great promise for facilitating implementation of evidence-based practices [ 35 ]. Audit and feedback has demonstrated that it can be an effective strategy for implementation [ 36 , 37 ], but there is little evidence to suggest that it is equally effective in achieving the sustainment stage of implementation [ 38 ].

Federal agencies responsible for wide-scale delivery of prevention programs, including the Substance Abuse and Mental Health Services Administration SAMHSA , routinely collect information from their grantees to monitor progress toward completion of goals and objectives.

SAMHSA supports a wide array of prevention grant programs targeting mental, emotional, and behavioral disorders including illicit substance use, suicide, and antisocial behavior. This information is used to provide feedback to grantees when there is evidence of failure to achieve goals and objectives.

However, there is no empirical evidence that such feedback leads to an improvement in performance or increases the likelihood of sustainment. While SAMHSA remains deeply concerned about sustainment, its mission does not allow monitoring of its grantees after funding has ended.

In building a partnership with SAMHSA, the National Institute on Drug Abuse NIDA -funded Center for Prevention Implementation Methodology Ce-PIM, P30DA responded to this need by undertaking the development of a sustainability measure across diverse prevention programs and test its predictive validity over time [ 39 ].

This measure was intended for use in a Sustainment Measurement System SMS , a process designed to evaluate likelihood toward successful sustainment of SAMHSA-funded programs and initiatives and to provide feedback to grantees that would enhance the likelihood of successful sustainment.

The objective of the current study was to explore and identify dimensions of the Sustainment Measurement System Scale SMSS that was designed to assess the sustainment of prevention programs and initiatives by generating quantitative items from qualitative content domains of sustainment outcomes and sustainability determinants and subjecting them to confirmatory factor analysis in order to discern their factor structure.

Our goal was to develop a scale that focused on the determinants and outcomes of sustainment of prevention programs and initiatives and to examine its factor structure, reliability, and construct validity.

Program Officers representing the 7 SAMHSA funding initiatives provided names and email addresses of all project directors and key personal for each organization currently or previously funded under these initiatives.

Researchers identified other people to contact from information provided by project directors of all PPS grantees funded by RFA SM Names and email addresses for two to three contacts i.

Invitations to participate in the study were sent to representatives of grantee sites supported by the 7 SAMHSA grants between November and March One-hundred eighty-six representatives of grantees agreed to participate, resulting in an individual representative response rate of The study was approved by the appropriate Institutional Review Boards prior to participant recruitment, and informed consent was obtained prior to administering surveys.

Study data were collected and managed using REDCap electronic data capture tools hosted at Northwestern University. REDCap Research Electronic Data Capture is a secure, web-based application designed to support data capture for research studies, providing 1 an intuitive interface for validated data entry, 2 audit trails for tracking data manipulation and export procedures, 3 automated export procedures for seamless data downloads to common statistical packages, and 4 procedures for importing data from external sources [ 40 ].

Each participant was emailed an invitation to participate including a link to the web-based survey. Participants reviewed informed consent and after agreeing to participate were able to access the survey and proceed to the survey items. Once participants logged in to the online survey, they were able to answer questions and could pause and resume at any time.

Item development for the SMSS is described in detail elsewhere [ 41 ]. The CFIR template was used to determine whether the components believed to be associated with successful implementation are also associated with successful sustainment. Templates of the PSAT and SIC sustainability measures informed the semi-structured interview questions and analysis of the free-list exercise.

The data sets containing sustainability elements from each of the three components of the interview semi-structured interview, free lists, and CFIR checklist were then compared through a process of data triangulation i.

Items were then placed into three groups: 1 those that appeared in only one of the three data sets, 2 those that appeared on two of the three data sets, and 3 those that appeared on all three data sets. Four sustainability elements were identified by all three data sets: 1 ongoing coalitions, collaborations, networks, and partnerships; 2 infrastructure and capacity to support sustainability; 3 community need for program; and 4 ongoing evaluation of performance and outcomes.

An additional 11 elements were identified by two of three data sets: 1 availability of funding; 2 consistency with organizational culture; 3 evidence of positive outcomes; 4 development of a plan for implementation and sustainment; 5 presence of a champion; 6 institutionalization and integration of program; 7 institutional support and commitment; 8 community buy-in and support; 9 program continuity; 10 supportive leadership; and 11 opportunities for staff training [ 41 ].

To construct this survey, the fifteen elements were condensed to create a item scale divided into the following subscales:. Sustainment outcomes: 4 items assessing the continued operation of the program or initiative, including delivering prevention services to intended population that are evidence-based as described in the original application for funding and periodically measuring service fidelity.

Financial stability: 6 items measuring funding from federal, state, or local governments and non-profit and non-governmental sources, combination of earmarked and discretionary funding, sustained funding, financial support from diverse community interests, and financial solvency.

Infrastructure and capacity to support sustainment : 9 items measuring available resources for project implementation and sustainment, integration into operations of the organization and partners, advanced development of plans for implementing and sustaining the project, execution of the project according to these plans, adequacy of staff to sustain program goals and activities, sufficiency of training available to staff and community members, staff knowledge and supportive beliefs, and staff self-efficacy to implement the project.

Implementation leadership: 5 items measuring active engagement of leaders in project implementation and sustainment, involvement of community leaders in the project, appointment of someone responsible for coordinating project implementation and sustainment, support from a program champion, and process in place for sustainment in the event the champion leaves.

Monitoring, evaluation, and program outcomes: 3 items measuring ongoing evaluation of progress made toward sustainment, sufficiency, and timeliness of feedback about project delivery and quality improvement, and evidence of positive outcomes.

Study participants were asked to indicate level of agreement with a series of statements using a Likert scale ranging from 1 not at all to 5 all the time for the four items contained in one subscale measuring sustainment outcomes and seven different domains of determinants of sustainment; lower scores on all subscales indicate lower levels of agreement, while higher scores indicate higher levels of agreement with the respective statements.

Each subscale score is represented as an average of the scores for each item included in the subscale. The average of the scores for each item included in the Sustainment Outcomes subscale was defined as Global Sustainment.

Two sets of variables measuring characteristics of the funded programs and initiatives were included in the analysis to determine whether the association between sustainability determinants and sustainment outcome varied by one or more program characteristics and to assess the convergent and discriminant validity of the SMSS.

The first set included a categorical variable describing program type community or state and a categorical variable describing program focus mental health or substance use. To evaluate the psychometric properties of the SMSS, confirmatory factor analyses CFA with maximum likelihood estimation were conducted using EQS statistical software [ 44 , 45 ].

The aim of the CFA was to determine if the data fit the hypothesized model of sustainability determinants and sustainment outcomes based on the qualitative research conducted in earlier study described above [ 41 , 45 ].

CFA is commonly used to confirm a hypothesized model based on theory or prior empirical research, as well as evaluate the reliability and validity of measures employed in implementation research [ 15 , 17 , 18 , 46 , 47 , 48 ]. Initially, confirmatory factor analysis was applied to all 42 items to identify poorly performing items and test our hypothesized sustainment domain structure, followed by subsequent modifications based on resulting model modification indices and theoretical justification [ 49 ].

Poor items were those that had low reliability or poor fit i. Principal axis factoring PAF with Promax oblique rotation was also conducted to provide guidance on item reduction and construct reclassification. Principal axis factoring was selected for factor extraction because it allows for consideration of both systematic and random error [ 50 ], and Promax oblique rotation was utilized as we assumed that the derived factors would be correlated [ 51 ].

Three criteria were used to determine the number of factors to retain: 1 examination of the oblique rotated factor pattern matrix, 2 parallel analysis [ 52 ], and 3 interpretability of the factor structure as indicated in the rotated solution.

Examination of the rotated factor structure included identification of eigenvalues above 1. We then used four measures of model fit to assess model adequacy for the initial model and revised models: chi-square statistic, the comparative fit index CFI , root mean square error of approximation RMSEA , and the standardized root mean square residual SRMR.

CFI values greater than 0. An item to total correlation higher than. Item analyses were also conducted, including an examination of inter-item correlations and alpha if the item is removed.

Construct validity of an instrument is typically assessed by comparing constructs or measurements that theoretically should be related to one another to determine if that is the case convergent validity and by comparing concepts or measurements that are not supposed to be related to determine if they are actually unrelated discriminant validity [ 56 ].

Only 5 programs were no longer in operation at the time the study was conducted and therefore removed from the comparison, even though their mean values were lower than those for the other two types of programs. Current funding by the original SAMHSA initiative was chosen to assess the convergent validity of the SMSS as it was hypothesized that grantees currently funded would have higher mean scores of sustainment outcomes than grantees no longer funded.

Program status was chosen to assess the divergent validity of the SMSS because the determinants were hypothesized to be unrelated to whether the sustained program was adapted or not as long as it continued to exist. There were no missing values for any of the 4 sustainment outcome variables; however, missing data for each of the determinant variables ranged from The same 29 to 31 individual grantee representatives did not provide responses to any of the determinant items and were removed from analyses of sustainability determinants by sustainment outcomes or determinants by current funding status or program status.

As a result, A flow chart describing the numbers of participants from recruitment to data collection to data analysis is presented in Fig. The effects of nesting of individuals within grantees was confirmed by the absence of any differences in associations between determinants and outcomes by grantee and associations between determinants and outcomes by individual participants.

Details of participating representatives and programs used in the data analysis are provided in Table 1. Thirty-four of the grantees Furthermore, 92 grantees Individual representatives included 43 Results of the CFA analyses are presented in Table 2.

In the initial model, we gave no consideration of program type or program focus affecting either the measurement model e. Although the 6 sustainment subscales and 1 sustainment outcome subscale exhibited good to excellent reliability, CFA analyses indicated poor fit of the item nine-factor model labeled Initial Model across the four major indices chi-square, CFI, RMSEA, SRMR.

Elimination of items with a factor correlation of less than. Results of an exploratory factor analysis revealed 10 domains that included a segmentation of the responsiveness to community needs and values subscale into two subscales—responsiveness to community needs 2 items and responsiveness to community values 3 items —and a segmentation of infrastructure and capacity subscale into two subscales—organizational capacity 4 items and organizational staff capability 3 items.

Only 1 item community leadership loaded onto the 10th factor, which was also eliminated for further analysis. One of the items from the leadership subscale also exhibited a much higher loading in the coalition, partnerships, and networks factor.

The standardized factor loadings ranged from. The item version of the SMSS is provided in the Appendix. Table 3 shows the correlations among the SMSS subscales. Table 4 shows the results of correlations between the global sustainment outcome score and the 8 determinant subscale scores stratified by program type and focus.

Global sustainment was significantly associated with all 8 determinants in community-based programs and programs targeting substance use prevention. Global sustainment was associated with responsiveness to community needs and values and organizational capacity and staff capability in statewide prevention programs, and with six of the eight determinants all but financial stability and responsiveness to community needs in programs that focused on mental health.

A comparison of sustainment determinants and outcomes by program current funding status in provided in Table 5. The discriminant validity of the SMSS was assessed in comparisons of total sustainment outcomes and determinants by program status.

The results are presented in Table 6 below. The global sustainment outcome score and the individual measures of sustainment were significantly greater in programs that continued to exist in the same form. Although there exist other measures designed to evaluate sustainability of evidence-based programs and interventions from the point of view of the determinants of sustainability or sustainment as an outcome, the Sustainment Measurement System Scale SMSS is the first instrument designed to assess both sustainability determinants and sustainment outcomes.

Further, the SMSS is designed to assess different prevention programs of different types and foci. As such, it contains elements that are specific to particular programs but enable comparisons across different types of programs.

It also demonstrates some potential as a tool for providing feedback to organizations, enabling them to monitor their trajectory towards achieving the final stage of state of implementation and increase the likelihood of successfully doing so.

The SMSS draws from and shares several features of existing measures of sustainability. For instance, like the Stages of Implementation Completion Scale [ 12 ], the SMSS measures sustainment as an outcome and can be adapted for use as a tool for monitoring progress toward sustainment [ 13 ].

Unlike the SIC, it measures characteristics of programs and their inner and outer settings that predict these outcomes and excludes earlier phases of implementation.

Like the Program Sustainability Assessment Tool [ 15 ], Sustained Implementation Support Scale [ 17 ], and Program Sustainability Index [ 18 ], the SMSS measures determinants of sustainability and exhibits similar internal consistency, model fit, and construct validity.

With the possible exception of responsiveness to community values, the domains are highly correlated with one another. SMSS has similar chi-square significance, RMSS, and SRMR as the PSAT. All of these instruments have less than desirable CFI of. The SMSS is the product of a standardized process of eliciting determinants and outcomes of sustainability that are both specific to the program being sustained and generalizable to other types of programs and initiatives [ 41 ].

This approach is also more consistent with the Dynamic Sustainability Framework [ 5 ] and the growing consensus of sustainability as a dynamic process with changes in both determinants and outcomes over time. In this study, correlations between sustainability determinants and sustainment outcomes were stronger with community-based programs and programs targeting substance use than with state-based programs and programs targeting mental health.

However, there was consistency across programs by type and focus with respect to certain determinants such as responsiveness to community values which included adaptability , organizational capacity, and organizational staff capability. The design and evaluation of the SMSS also provides some important insights into sustainment as the final stage of the implementation of evidence-based prevention programs and initiatives.

The process of achieving sustainment is the product of eight domains of sustainability determinants: financial stability; responsiveness to community needs; responsiveness to community values; coalitions, partnerships, and networks; organizational capacity; organizational staff capability; implementation leadership; and evaluation and feedback and positive program outcomes.

Luke and colleagues [ 15 ] found similar associations between program manager and staff perceptions of sustainability of their programs and the determinants of funding stability, partnerships, organizational capacity, and program evaluation. Hodge and colleagues [ 17 ] found similar associations between sustained implementation of the Triple P parent training program and the determinants of program benefits, workplace support, and leadership style and.

Mancini and Marek [ 18 ] found similar associations between meeting at risk needs and the determinants of leadership competence, effective collaboration, demonstrating program results strategic funding, staff involvement and integration, and program responsivity.

Many of these determinants decline once funding that supported their implementation comes to an end, which is to be expected since many of them like coalitions, partnerships and networks, staff capability e. As predicted, however, it makes no difference whether the program continues to exist in same form as originally proposed or has been adapted to improve fit, also consistent with the Dynamic Sustainability Framework.

This may be because many programs are not necessarily implementing a specific practice, and some are just trying to sustain coalitions.

Nevertheless, there are a number of factors that limit the findings of this study. The findings reflect the experience of specific prevention programs and initiatives that have been or are currently funded by SAMHSA; thus, their generalizability to prevention programs funded by other sources e.

The confirmatory factor analysis was constrained by the small number of programs and program representatives. Only two items loaded onto one of the identified constructs responsiveness to community needs , while only three items loaded onto the construct of responsiveness to community values.

Further research is required to determine whether or not they represent two distinct constructs. With these limitations in mind, future steps include the following: 1 evaluation of the utility of the SMSS with other types of programs in other settings, 2 use of larger samples to confirm fit of the data to the model, 3 development of guidelines for providing feedback to organizations seeking to sustain programs and initiatives based on ongoing monitoring efforts using the SMSS, and 4 consistent with the SMS process, ongoing revision of the tool itself.

The SMSS is innovative in three specific respects. First, it draws upon the experience of evaluating sustainability in different types of prevention programs and initiatives with different aims and areas of emphases.

Second, although we did not assess the effectiveness of the various programs, practices, and initiatives participating in this study, a measure like the SMSS offers the potential to determine whether the extent to which a program or practice is evidence-based or evidence-informed determines whether it can be sustained.

Such information would be invaluable to determining whether the program or practice merits initial or continued funding. Third, this measure can be used to monitor progress toward sustainment and provide feedback to stakeholders as to how to increase the likelihood of sustainment.

The SMSS in particular and the SMS in general can be used as a tool for program management as well as research purposes. Although the SMSS was based on programs funded by SAMHSA, the instrument should have general applicability across diverse federal, statewide, and local prevention implementation initiatives.

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