Welcome to the Accin Mutua webseminar

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Welcome to the Acción Mutua web-seminar
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• Acción Mutua is a capacity building assistance
  (CBA) program of AIDS Project Los Angeles in
  collaboration with the César E. Chávez Institute
  of San Francisco State University
• Funded by the Centers for Disease Control and
  Prevention

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Retaining Clients in HIV Prevention Programs

• Ted Duncan
• Centers for Disease Control and Prevention

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Focus of the Presentation

• Addresses issues related to client retention not
  the retention of volunteers, staff or board
  members
• Based primarily on lessons learned from CBO
  facing challenges with client retention, not peer
  review literature searches

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Presentation Objectives

• Describe what client retention is and why it is
  important
• Describe the guiding principles for retention
• Identify retention strategies
• Describe how to plan for retention

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What is Retention?

• Maintaining client participation for the duration
  of the intervention cycle
• Multi-session group level or individual level
  interventions Completion of all sessions
  required for the delivery of the intervention
• Completion of all sessions required to complete
  prevention plan

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Why is Retention Important?

• To realize full effect of an intervention,
  clients must receive full dosage.
• The effectiveness of an effective intervention
  was demonstrated among those who completed it and
  not those who dropped out
• No intervention is effective if people do not
  stay in it.
• A client who does not complete the intervention
  or service cycle is taking the place of a client
  who may have.

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Retention Rate

• Proportion of people starting an intervention who
  complete it
• What is an acceptable rate?
• It depends on
• The population
• The intervention
• Requirements of the funder
• Standards of the agency
• External factors

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Guiding Principles of Retention

• Provide high quality customer service
• Understand the characteristics of the target
  population
• Implement and deliver services that are
  appropriate for the target population and setting
• Provide services and interventions that are
  meaningful to target population

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Guiding Principles of Retention (continued)

• Communicate with clients
• Be responsive to their needs and their need for
  agency services
• Set objectives for retention rates and then
  monitor them
• Revise retention strategies as needed
• Anticipate barriers to retention and plan around
  them

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Major Facilitators/Barriers to Retention

• Location Is it safe, convenient, easy to get
  to, and in a zone of comfort?
• Environment Is it comfortable and confidential?
• Quality of interaction Is it inclusive,
  non-judgmental, non-coercive, and speaks to the
  person and their issues?
• Expectations Are participants clear on the
  intervention, process, and commitment?
• Convenient Are there opportunities to access
  other services?

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Major Facilitators/Barriers to Retention
(continued)

• Schedule Is it on the right day and at the
  right time?
• Amenities Are refreshments and food available?
• Competing priorities Is there anything else in
  a persons life that may interfere, but can be
  planned around? (For instance, childcare needs
  for women)
• Social opportunities Do people have the
  opportunity to socialize casually?

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Retention Strategies

• Organized, effective implementation of
  intervention or service
• Communication
• Telephone calls
• Post cards
• Reminders at scheduled visits for other services
• Newsletters
• Email messages
• Reminders at the end of each session

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Retention Strategies (continued)

• Set an objective for retention rate.
• Example 80 of all clients who enroll in each
  cycle of Safety Counts will complete all sessions
• Monitor retention rate to determine whether
  objectives are being met.
• Try to understand why the objective was not met.
• Revise retention strategy or objective as
  appropriate.

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Retention Strategies (continued)

• Tailor strategies to fit the type of Intervention
• Interventions delivered to individuals
• Engage and get to know the individual
• Communicate interest in the client as a person
• Utilize good communication
• Provide support someone to listen to them
• Involve significant others

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Retention Strategies (continued)

• Ask why those who enrolled in the intervention
  dropped out
• Clients who dropped out, clients who didnt drop
  out, key informants
• Is there a pattern to the reasons for dropping
  out?
• Can you plan around the reasons?

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Retention Strategies (continued)

• For interventions delivered to groups
• Think about retention strategies from the
  perspective of gender, race/ethnicity, behavior,
  etc.
• Communicate concern of the welfare of absent
  participants
• Convey to absent participants that he/she was
  missed by the group (handwritten note, telephone
  call, etc.)

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Retention Strategies (continued)

• Use incentives
• Identify what appeals to target population
• Offer choices and combinations
• Make sure incentives are culturally appropriate
• Check with funder before offering cash
• Consider
• Food and refreshments
• Gift certificates
• Raffles
• Cards
• Small gifts (Calendars, pens, toiletries, etc.)
• Recognition Certificate of Completion or
  Graduation Ceremony

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Retention Strategies (continued)

• Try to identify the characteristics of those who
  complete the intervention as opposed to those who
  drop out.
• Is there a pattern?
• Once risk and eligibility is established, screen
  for characteristics that are associated with
  likelihood of completion.

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Retention Strategies (continued)

• Pay attention to the point in an intervention
  cycle clients drop out.
• Is there a pattern?
• If so, what happened in the session immediately
  before that may have contributed to clients not
  coming back?
• Can you fix it?

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Retention Planning

• Before the intervention or services
• During the delivery of the intervention or
  services
• Follow up to the delivery of the intervention or
  service

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Retention Planning (continued)

• Specific strategies to maintain participation
  depend on
• The nature of the intervention or service
• The characteristics of the target population
• Organizational needs, resources, and capacity

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Retention Planning (continued)

• What environment would be most comfortable
• Take culture into consideration
• Ensure physical comfort
• Provide a sense of safety
• Be sure there is comfort with staff providing
  service or implementing intervention
• Ensure confidentiality of setting

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Retention Planning (continued)

• Plan retention during recruitment
• Develop screening tools
• In screening, try to identify potential barriers
  and plan for addressing them
• Ensure client is appropriate for the intervention
• Assess clients ability to complete intervention

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Retention Planning (continued)

• Secure client contact information at enrollment
• Get contact information of two people who do not
  live with the client but would know whereabouts
• Obtain permission to make contact

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Retention Planning (continued)

• Build a sense of ownership during intervention or
  service delivery
• Involve them in the retention process
• Solicit their input on why some people drop out
• Encourage a mutually supportive atmosphere to
  complete intervention
• Use process monitoring to see if retention
  strategies are effective

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Retention Planning (continued)

• Utilize intake process
• Explain purpose of intervention
• Be honest about requirements and expectations
• Dont use coercion
• Secure client buy-in
• Build client confidence to complete the
  intervention

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The Bottom Line

• Use evidence to make decisions about retention
• Plan for retention before starting the
  intervention
• Screen clients for risk, eligibility, and
  appropriateness for the intervention
• Set retention objectives and retention rates
• Attempt to understand why people drop out of an
  intervention find ways of addressing the causes
• Keep trying!

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iGracias Thank You!
Questions Answers
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For more information on this presentation,
contact

• Ted Duncan
• CDC
• 1600 Clifton Road, MS-E40
• Atlanta, GA 30333
• tfd2_at_cdc.gov

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