Another major challenge has been the sustainability of such a large effort. Changes in senior leadership and university priorities can have a significant impact on the scope of the project and associated translational activities. Enrolling new cohorts annually would allow us to track whether the implementation of various translational initiatives has an impact on substance use and mental health; however, practically, this has been difficult, as inconsistent funding has led to gaps in cohort enrollment, and an inability to systematically study outcomes associated with our translational initiatives.
