Considering the prevention workforce: a study on practitioner needs when recommending substance use interventions

Background: 

Uptake of evidence-based and evidence-informed interventions in substance use prevention continues to be limited. Substance use prevention funders drive uptake by guiding practitioners in identifying strategies that offer the best fit for their context. Considerations about intervention uptake require intervention acceptability on the part of the practitioner; limited research exists on how funders consider practitioner needs when it comes to recommending substance use prevention interventions. The purpose of this NIDA-supported study was to define the funding infrastructure for substance use prevention in the US and describe considerations of intervention selection among officials and practitioners.

Methods: 

National Prevention Network representatives (NPNs) and substance use practitioners were surveyed and follow-up qualitative interviews with NPNs contextualized their responses. Data collection and analysis was guided by an implementation science framework—the Consolidated Framework for Implementation Research—and with expert review by substance use prevention program researchers. Survey development included cognitive testing with 9 practitioners to refine items and determine relevancy.

Results:

41 NPNs and 216 practitioners from 41 states and jurisdictions completed surveys; 16 NPNs did follow-up semi-structured interviews. Nearly half (47%) had been in the substance use prevention field for at least 10 years. NPNs were surveyed on decision making priorities around recommending substance use prevention strategies, half reporting they recommend or require practitioners to select evidence-based preventions strategies from a list or registry for at least some of their funded programs; fewer stated that they required specific strategies. When asked about factors considered when deciding to recommend or require a substance use prevention strategy, NPNs endorsed consideration of practitioner ease of delivery or adaptability the least. Both NPNs and practitioners reported that consideration of how well the intervention effectively addressed substance use risk and protective factors or outcomes they targeted was most important. In contrast to NPNs, practitioners reported feasibility and financial resources as important considerations in intervention selection.

Conclusions: 

Funding infrastructure for substance use prevention in the US is largely tied to requirements of state officials. Our study found a mismatch between NPNs and practitioners with the latter placing greater emphasis on practitioner feasibility and adaptability of substance use prevention strategies. Further research is needed on why certain characteristics of interventions are considered over others when they are being recommended by officials, and how this impacts long-term maintenance and sustainability. In order to address long-term program sustainability and workforce capacity, substance use prevention programs must consider practitioner needs in uptake and delivery.