Abstract
Implementation and sustainment of evidence-based interventions (EBIs) is influenced by outer (e.g., broader environments in which organizations operate) and inner (e.g., organizations, their administrators, and staff) contexts. One important outer-context element that shapes the inner context is funding, which is complex and unpredictable. There is a dearth of knowledge on how funding arrangements affect sustainment of EBIs in human service systems and the organizations delivering them, including child welfare and behavioral health agencies. This study uses qualitative interview and focus group data with stakeholders at the system, organizational, and provider levels from 11 human service systems in two states to examine how stakeholders strategically negotiate diverse and shifting funding arrangements over time. Study findings indicate that, while diverse funding streams may contribute to flexibility of organizations and possible transformations in the human service delivery environment, a dedicated funding source for EBIs is crucial to their successful implementation and sustainment.
Similar content being viewed by others
Explore related subjects
Discover the latest articles, news and stories from top researchers in related subjects.References
Chamberlain P, Roberts R, Jones H, et al. Three collaborative models for scaling up evidence-based practices. Administration and Policy in Mental Health & Mental Health Services Research. 2012;39(4):278–290.
Aarons GA, Hurlburt M, Horwitz SM. Advancing a conceptual model of evidence-based practice implementation in public service sectors. Administration and Policy in Mental Health & Mental Health Services Research. 2011;38(1):4–23.
Gronbjerg KA. Understanding nonprofit funding: managing revenues in social services and community development organizations. San Francisco, CA: Jossey-Bass Publishers, 1993.
Collins-Camargo C, McBeath B, Ensign K. Privatization and performance-based contracting in child welfare: recent trends and implications for social service administrators. Administration in Social Work. 2011;35(5):494–516.
Smith SR. The political economy of contracting and competition. In: Hasenfeld Y (Ed). Human services as complex organizations, second edition. Thousand Oaks, CA: Sage Publications, 2010, pp. 139–160.
Willging CE, Aarons GA, Trott EM, et al. Contracting and procurement for evidence-based interventions in public-sector human services: a case study. Administration and Policy in Mental Health & Mental Health Services Research. 2016;43(5):675–692.
Smith JR, Lipsky M. Non-profits for hire: the welfare state in the age of contracting. Cambridge, MA: Harvard University Press, 1993.
Bunger AC, Collins-Camargo C, McBeath B, et al. Collaboration, competition, and co-opetition: interorganizational dynamics between private child welfare agencies and child serving sectors. Children and Youth Services Review. 2014;38:113–122.
Stroul BA, Manteuffel BA. The sustainability of systems of care for children’s mental health: lessons learned. Journal of Behavioral Health Services & Research. 2007;34(3):237–259.
Gronbjerg KA, Martell L, Paarlberg L. Philanthropic funding of human services: solving ambiguity through the two-stage competitive process. Nonprofit and Voluntary Sector Quarterly. 2000;29(suppl 1):9–40.
Kearns KP, Bell D, Deem B, et al. How nonprofit leaders evaluate funding sources: an exploratory study of nonprofit leaders. Nonprofit and Voluntary Sector Quarterly. 2014;43(1):121–143.
AbouAssi K. Hands in the pockets of mercurial donors: NGO response to shifting funding priorities. Nonprofit and Voluntary Sector Quarterly. 2013;42(3):584–602.
Kaynama SA, Keesling G. An empirical investigation of the nonprofit organization responses to anticipated changes in government support for HIV/AIDS services: a cross-regional analysis. Journal of Business Research. 2000;47(1):19–26.
McMurtry SL, Netting FE, Kettner PM. How nonprofits adapt to a stringent environment. Nonprofit Management and Leadership. 1991;1(3):235–252.
Thompson JD. Organizations in action. New York, NY: McGraw-Hill, 1967.
Damschroder LJ, Aron DC, Keith RE, et al. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implementation Science. 2009;4:50.
Jones AM, Bond GR, Peterson AE, et al. Role of state mental health leaders in supporting evidence-based practices over time. Journal of Behavioral Health Services & Research. 2014;41(3):347–355.
Massatti RR, Sweeney HA, Panzano PC, et al. The de-adoption of innovative mental health practices (IMHP): why organizations choose not to sustain an IMHP. Administration and Policy in Mental Health and Mental Health Services Research. 2008;35(1–2):50–65.
Romance NR, Vitale MR, Dolan M, et al. An empirical investigation of leadership and organizational issues associated with sustaining a successful school renewal initiative. Paper presented at the Annual Meeting of the American Educational Research Association. New Orleans, Louisiana, 2002.
Meyers DC, Durlak JA, Wandersman A. The quality implementation framework: a synthesis of critical steps in the implementation process. American Journal of Community Psychology. 2012;50(3–4):462–480.
Gershater-Molko RM, Lutzker JR, Wesch D. Project SafeCare: improving health, safety, and parenting skills in families reported for, and at-risk for child maltreatment. Journal of Family Violence. 2003;18(6):377–386.
Chaffin M, Hecht D, Bard D, et al. A statewide trial of the SafeCare home-based services model with parents in child protective services. Pediatrics. 2012;129(3):509–515.
Whitaker DJ, Ryan KA, Wild RC, et al. Initial implementation indicators from a statewide rollout of SafeCare within a child welfare system. Child Maltreatment. 2012;17(1):96–101.
Aarons GA, Sommerfeld DH, Hecht DB, et al. The impact of evidence-based practice implementation and fidelity monitoring on staff turnover: evidence for a protective effect. Journal of Consulting and Clinical Psychology. 2009;77(2):270–280.
Aarons GA, Green AE, Palinkas LA, et al. Dynamic adaptation process to implement an evidence-based child maltreatment intervention. Implementation Science. 2012;7:32.
Hurlburt M, Aarons GA, Fettes DL, et al. Interagency collaborative team model for capacity building to scale-up evidence-based practice. Children and Youth Services Review. 2014;39:160–168.
Aarons GA, Green AE, Willging CE, et al. Mixed-method study of a conceptual model of evidence-based intervention sustainment across multiple public-sector service settings. Implementation Science. 2014;9:183.
Aarons GA, Fettes DL, Hurlburt MS, et al. Collaboration, negotiation, and coalescence for interagency-collaborative teams to scale-up evidence-based practice. Journal of Clinical Child and Adolescent Psychology. 2014;43(6):915–928.
Stirman SW, Kimberly J, Cook N, et al. The sustainability of new programs and innovations: a review of the empirical literature and recommendations for future research. Implementation Science. 2012;7:17.
QSR International. NVivo Qualitative Data Analysis Software, Version 10 [computer program]. 2012.
Patton MQ. Qualitative research & evaluation methods: integrating theory and methods, fourth edition. Thousand Oaks, CA: Sage Publications, 2015.
Corbin J, Strauss A. Basics of qualitative research: techniques and procedures for developing grounded theory, third edition. Thousand Oaks, CA: Sage Publications, 2008.
Glaser BG, Strauss AL. The discovery of grounded theory: strategies for qualitative research. New York, NY: Aldine de Gruyter, 1967.
Morreale JC. The impact of the “Great Recession” on the financial resources of nonprofit organizations. Wilson Center for Social Entrepreneurship. 2011: Paper 5. http://digitalcommons.pace.edu/wilson/5
Aarons GA, Ehrhart MG, Farahnak LR. The Implementation Leadership Scale (ILS): development of a brief measure of unit level implementation leadership. Implementation Science. 2014;9:45.
Aarons GA, Green AE, Trott EM, et al. The roles of system and organizational leadership in system-wide evidence-based intervention sustainment: a mixed-method study. Administration and Policy in Mental Health & Mental Health Services Research. 2016;43(6):991–1008.
Aldrich HE. Organizations and environments. Englewood Cliffs, NJ: Prentice-Hall, 1979.
Pfeffer J. New directions for organization theory: problems and prospects. Oxford, UK: Oxford University Press, 1997.
Aldrich HE, Ruef M. Organizations evolving, second edition. Thousand Oaks, CA: Sage Publications, 2006.
Meyer JW, Scott WR. Organizational environments, ritual and rationality. Newbury Park, CA: Sage Publications, 1992.
DiMaggio PJ, Powell WW. The Iron Cage revisited: institutional isomorphism and collective rationality in organizational fields. American Sociological Review. 1983;48(2):147–160.
DiMaggio PJ, Powell, WW (Eds). The new institutionalism in organizational analysis. Chicago, IL: University of Chicago Press, 2012.
Romzek BS, Johnston JM. Effective contract implementation and management: a preliminary model. Journal of Public Administration Research and Theory. 2002:12(3):423–453.
Flaherty C, Collins-Camargo C, Lee E. Privatization of child welfare services: lessons learned from experienced states regarding site readiness assessment and planning. Children and Youth Services Review. 2008;30(7):809–820
Aarons GA, Ehrhart MG, Farahnak LR, et al. Aligning leadership across systems and organizations to develop a strategic climate for evidence-based practice implementation. Annual Review of Public Health. 2014;35:255–274.
Baker T, Nelson RE. Creating Something from Nothing: Resource Construction through Entrepreneurial Bricolage. Administrative Science Quarterly. 2005;50(3):329–366.
Desa G. Resource Mobilization in International Social Entrepreneurship: Bricolage as a Mechanism of Institutional Transformation. Entrepreneurship Theory and Practice. 2012;36(4):727–751.
Bunger AC. Administrative coordination in non-profit human service delivery networks: the role of competition and trust. Nonprofit and Voluntary Sector Quarterly. 2013;42(6):1155–1175.
Crittenden WF. Spinning straw into gold: the tenuous strategy, funding, and financial performance linkage. Nonprofit and Voluntary Sector Quarterly. 2000;29(suppl 1):164–182.
Marwell NP, Calabrese T. A deficit model of collaborative governance: government-nonprofit fiscal relations in the provision of child welfare services. Journal of Public Administration Research and Theory. 2014;25:1031–1058.
Saldana L, Chamberlain P, Bradford WD, et al. The Cost of Implementing New Strategies (COINS): a method for mapping implementation resources using the stages of implementation completion. Children and Youth Services Review. 2014;39:177–182.
Amirkhanyan AA, Kim HJ, Lambright KT. Closer than “arms length”: understanding the factors associated with collaborative contracting. The American Review of Public Administration. 2012;42(3):341–366.
White H. Current challenges in impact evaluation. European Journal of Development Research. 2014;26(1):18–30.
McCarthy P, Kerman B. Inside the belly of the beast: how bad systems trump good programs. Administration and Policy in Mental Health and Mental Health Services Research. 2010;37(1–2):167–172.
Allard SW, Smith SR. Unforeseen consequences: Medicaid and the funding of nonprofit service organizations. Journal of Health Politics, Policy, & Law. 2014;39(6):1135–1172.
Acknowledgements
This study is supported by U.S. National Institute of Mental Health grants R01MH072961 and R01MH092950, National Institute on Drug Abuse grant R01DA038466, and U.S. Centers for Disease Control grant R01CE001556 (Principal Investigator—Gregory A. Aarons). We thank participants from the service systems, organizations, and the participating providers and coaches for their collaboration and involvement in this study.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
The authors certify that they have no financial or non-financial interest in the subject matter or materials of this manuscript.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Jaramillo, E.T., Willging, C.E., Green, A.E. et al. “Creative Financing”: Funding Evidence-Based Interventions in Human Service Systems. J Behav Health Serv Res 46, 366–383 (2019). https://doi.org/10.1007/s11414-018-9644-5
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11414-018-9644-5