Cohort 7

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• Cohort 7
• SPF SIG Step 4
• Its Time for A Pulse Check Implementation,
  Fidelity, Adaptation

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Facilitators
Hanover F/G Hanover A/B Deborah McLean Leow,
NECAPT Tasha Wilkerson, CCAPT Kathleen Gary,
SWCAPT Shai Fuxman, NECAPT Lourdes Vázquez,
SECAPT Carlos Morales, CCAPT Michael Langdon,
CCAPT Chuck Daugherty, SWCAPT
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• INTRODUCTION OVERVIEW

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Agenda/Roadmap

• Introduction and Overview
• Acquaintance Exercise
• Presentation
• Pulse Check Exercise
• Large Group Sharing of Salient Points and A-ha
  Moments
• Evaluations

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Purpose

• During this session, participants will be able
  to
• Discuss and define the concepts of cultural
  competency, fidelity, adaptation, process
  evaluation
• Discuss the strategies used by participants to
  adapt an evidence-based program to match the
  needs of a specific audience.
• Share examples and lessons learned regarding how
  fidelity and adaptation have been used in
  programs.

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Getting Acquainted Please Stand Up Exercise

• Please Stand If You
• Are an evaluator
• Are a program director
• Work in an urban setting
• Work in a suburban setting
• Work in a rural setting
• Move to designated area
• Re-entry youth
• Re-entry Adults
• Women
• Men/MSM
• Young adults (18-25)
• Adolescents (12-17)
• Returning veterans or older adults

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Small Group Work Priority Populations

• At tables participants will identify
• What are some of the unique characteristics of
  your target audience that may require adaptations
  to your identified program/intervention?
• Fill in first part of worksheet
• Volunteer from each table write on newsprint

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• STRATEGIC PREVENTION FRAMEWORK (SPF)
• Benchmarks for Step 4

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SAMHSAs Strategic Prevention Framework Steps
Assessment
Evaluation
Capacity
Implementation
Planning
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Key Milestones for SPF Step 4

• A refined logic model
• An updated strategic plan that responds to
  ongoing needs/resources assessment
• Procedures to ensure cultural competency
• Fidelity and implementation monitoring

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Polling Question

• How many of you have completed a community- or
  outcomes-focused logic model?
• a) Just getting started
• b) Almost there
• c) Completed
• d) Not applicable

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Logic Model The Big Picture

• Depicts a simplified picture of a program,
  initiative, or intervention that is a response to
  a given situation.
• Shows the logical relationship among the
  resources that are invested, the activities that
  take place, and the benefits or changes that
  result.
• Provides the core to program planning,
  evaluation, and program management and
  communications.

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Logic Model for Minority Prison Re-Entry
Population (Sample)
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Polling Question Strategic Plan

• How many of you have completed a Strategic Plan?
• a) Just getting started
• b) Almost there
• c) Completed
• d) Not applicable

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Components of a Strategic Plan

• Lays the groundwork for
• Identification of strategies
• Selection of evidence-based programs, policies,
  and practices
• Implementation activities
• Opportunities for evaluation

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Polling Question Cultural Adaptations

• How many of you have identified a need to make
  planned adaptations to your selected
  intervention(s)?
• a) Just getting started
• b) Almost there
• c) Completed
• d) Not applicable

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Cultural Competence - Individuals

• A set of academic and interpersonal skills that
  allows individuals to increase their
  understanding and appreciation of cultural
  differences and similarities within, among, and
  between groups.
• Requires a willingness and the ability to draw on
  community-based values, traditions, and customs,
  and to work with knowledgeable persons of and
  from the community in developing focused
  interventions, communications, and other
  supports.
• Orlandi et.al.,(1992)

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Cultural Competence - Systems

• A set of congruent behaviors, attitudes and
  policies that come together in a system, agency
  or among professionals and enable that system,
  agency or those professionals to work effectively
  in cross-cultural situations

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HRSA/DHHS indicators of Cultural Competence in
Health care Delivery Organizations A
organizational Cultural Competence Assessment
Profile, prepared by Lewin Group Inc, April 2002
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Cultural Competence - SPF

• Ensure community involvement in all areas.
• Stress the importance of relevant, culturally
  appropriate approaches.
• Support the development of culturally specific
  services.
• Employ culturally competent evaluators.
• Promote organizational cultural competence.
  Staff should reflect the community they serve.
• Include sub-groups in each step of the SPF
  process.

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Cultural Competence - Implementation

• Involve community in the implementation of a
  strategic plan
• Create a feedback loop for communicating efforts
  and successes
• Make appropriate cultural adaptations and put
  processes in place to track these changes

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Fidelity Did you keep it the same?

• The agreement (concordance) of a replicated
  program or strategy with the specification of the
  original. (CSAPs Prevention Platform, 2005)
• The degree of fit between the developer-defined
  components of a program and its actual
  implementation in a given organizational or
  community setting. (Backer, 2002)

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Guidelines for Implementing with Fidelity

• 1. Identify and understand the theory base behind
  the program.
• Contact the program developer
• Locate published literature
• Contact your CAPT
• 2. Identify core components of program.
• Program content
• Delivery format
• Delivery time
• Location
• Qualifications of program deliverer

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Guidelines for Implementing with Fidelity

• 3. Develop a plan to maintain program
  implementation
• Add a system/procedure for monitoring
  implementation
• Add a process evaluation plan

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Adaptation How did you change it?

• Changes or departures from the methodology
  enlisted in the original implementation of the
  program or strategy. (Cummins, et al., 2002)
• Intention can be either deliberate or
  accidental (Backer, 2002)
• Characteristics additions, deletions, or
  modifications to the original implementation of
  the program (Cummins, et al., 2002)

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Types of Adaptations

• WHAT is the nature of the program? Changes to the
  content of sessions?
• HOW is the program delivered? Changes to the
  number of sessions, materials used, length of
  sessions, etc.?
• TO WHOM is program delivered? Changes to the
  target population e.g. of participants age,
  gender, ethnicity of participants, recruitment
  method?
• WHERE is program delivered? Changes to the
  setting/location?
• WHO delivers the program? Changes to the delivery
  agents e.g. number of staff/volunteers, training
  required, etc.?

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Guidelines for Adaptation

• 1. Identify the need for adaptation based on
• Delivery time
• Target population
• Community
• Politics
• Circumstances
• Culture
• Historical experience
• Stakeholders interests

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Polling Question Process Evaluation

• How many of you have a process in place to track
  program implementation?
• a) Just getting started
• b) Almost there
• c) Completed
• d) Not applicable

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Monitoring the implementation of the strategic
plan

• Process Evaluation Assessment of program
  materials and activities.
• www.evaluationwiki.org/index.php/Evaluation_Defin
  ition

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Guidelines for Adaptation

• 2. Communicate with the program developer,
  organizations implementing the program and
  representatives of the community.
• 3. Develop overall implementation plan.
• 4. Develop overall evaluation plan. Measure
  process (did the adaptation work as planned?) and
  outcomes as a result of implementing the adapted
  program.

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Monitoring the implementation of the strategic

• Process Evaluation
• Assessment of program materials and activities
• Process by which you monitor the implementation
  of your strategic plan
• www.evaluationwiki.org/index.php/Evaluation_Defin
  ition

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Relevance of the Intervention (Addresses community condition or underlying risk or protective factors) Relevance of the Intervention (Addresses community condition or underlying risk or protective factors) Relevance of the Intervention (Addresses community condition or underlying risk or protective factors) Relevance of the Intervention (Addresses community condition or underlying risk or protective factors) Relevance of the Intervention (Addresses community condition or underlying risk or protective factors)
Intervention Selection Intervention Content Intervention Outcome Identified (As designed) Community Outcome CSAP Outcome
Program Practice Policy Social resistance training Reduce onset or heavy use among experimenters of marijuana and tobacco Reduce substance abuse and HIV infection among the Hispanic young adult population in Reno, NV Reduce Substance Abuse Reduce HIV transmission rates
Fidelity to Core Components of the Intervention Fidelity to Core Components of the Intervention Fidelity to Core Components of the Intervention Fidelity to Core Components of the Intervention Fidelity to Core Components of the Intervention
Core component 1 Intervention Target Population Actual population participating in your intervention? Changes made? Resources used for changes? Training/ TA used for changes?
At-risk youth, ages 14-19 years old High-risk youth, alternative/ continuation high schools Diverse population Young adult Hispanics, ages 18-24 years old 24 participants per cycle Yes No N/A (Examples Recruitment and retention Incentives) N/A (Examples TA from MAI Cohort 6)
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Core component 2 Intervention Number of Sessions per Cycle Actual number of sessions per cycle you delivered? Changes made? Resources used for changes? Training/ TA used for changes?
12 sessions, Weekly, 12 consecutive wks. Session 1 Active Listening Session 2 Stereotyping Session 3 Myths/ Denials Session 4 Chemical Dependency Session 5 Talk Show Session 6 Marijuana Panel Session 7 Tobacco Basketball/ Use Cessation Session 8 Stress, Health, and Goals Session 9 Self-Control Session 10 /- Thought Behavior Loop Session 11 Perspectives Session 12 Decision-making/ Commitment 10 sessions, 2X/weekly for 5 consecutive wks. Or 10 sessions, 1X/weekly for 10 consecutive wks. Session 1 Orientation Session 2 Active Listening Stereotyping Session 3 Myths/Denials Chemical Dependency Session 4 Talk Show Marijuana Panel Session 5 Tobacco Basketball/Use Cessation Stress, Health, and Goals Session 6 VOCES Session 7 Hepatitis 101 Presentation Session 8 Self-Control /- Thought Behavior Loop Session 9 Perspectives Session 10 Graduation Yes No Enhancements Added orientation Added another model program Added HIV counseling, testing and referral services Added Hepatitis/STD prevention, testing Added graduation Eliminations None Training in VOCES model program Technical assistance in HIV/ Hepatitis/ STD counseling, testing and referral
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Core component 3 Intervention Length of Sessions Actual length of your sessions? Changes made? Resources used for changes? Training/ TA used for changes?
45-50 minutes, each session 2 hour, each session with delivery of cores at 1 hr. each. Yes No Extended facility/ room reservation N/A
Core component 4 Intervention Location/ Setting Actual location/ setting where your intervention was delivered? List each location. Changes made? Resources used for changes? Training/ TA used for changes?
School-based setting, classroom Non-profit facility Yes No TV monitor, DVD player Write-on White Board N/A
Core component 5 Intervention Delivery Staff Who delivered your intervention at each location/ setting? Changes made? Resources used for changes? Training/ TA used for changes?
Trained TND facilitator, Peer leaders Trained TND facilitator, trained VOCES facilitator, SAMHSA Consultants, Nurse, Peer leaders Yes No Enhancement Added SAMHSA Consultants Added Public Health Dept. Nurse Same
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Cultural Responsiveness to the Implementation of the Intervention Cultural Responsiveness to the Implementation of the Intervention Cultural Responsiveness to the Implementation of the Intervention Cultural Responsiveness to the Implementation of the Intervention Cultural Responsiveness to the Implementation of the Intervention
Changes made to Program Content? Reasons for changes? Feedback from participants? Feedback from delivery staff? Changes made as result of feedback?
Yes No N/A Very receptive and engaged Easy to deliver good support materials None
Changes made to Program Delivery? Reasons for changes? Feedback from participants? Feedback from delivery staff? Changes made as result of feedback?
Yes No Integration of TND and VOCES in an effort to prevention SA and HIV among target population. Discussion with program developer was possible to integrate HIVP and HepP into curriculum. Meaningful and participants appreciated shorter session numbers. More comprehensive delivery design. Able to address multiple needs of population. Changed proposed time to a time that participants wanted. (From afternoons to evenings.)
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Pulse Check Exercise Peer Exchange

• Small Group by Priority Population
• At tables complete questions 2-6 of Pulse Check
  Worksheet
• Each table should be prepared to share a brief
  summary of your discussion
• Large Group Report-Out
• A-ha Moments/Highlights

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Evaluations