Needs Assessment

Needs Assessment Slides for Module 4 Topic: Implementing Needs Assessment

Implementing Needs Assessment • Designing and Managing Needs Assessment • Analyzing and Presenting Needs Assessment Findings

Training Objectives Following the training, participants will be able to: Describe 3 strategies for maximizing consumer and other PLWH involvement in needs assessment Identify 5 factors to consider in making needs assessment findings understandable and useful for decision making • Identify at least 4 different data gathering methods for use in needs assessment • Describe 4 steps in designing and implementing needs assessment • Describe 3 strategies for doing needs assessment with limited resources • Outline a multi-year needs assessment plan appropriate for their EMA or TGA

Designing and Managing Needs Assessment • Data-Gathering Methods • Using a Multi-Year Plan • Needs Assessment Steps and Staffing • Controlling Needs Assessment Costs • Maximizing Consumer Input • Prevention-Care Needs Assessment

Choosing Needs Assessment Methods Many data-gathering methods available: • Some quick, others requiring extensive preparation • Some inexpensive, others requiring extensive resources (people and/or funds) • Some that call for extensive research and data skills, others manageable without extensive training

Data-Gathering Methods:Necessary Aspects • Approaches to implement each needs assessment component requiring new data collection • A combination of: • Quantitative data: information that can be expressed in numbers and counted – like epi or client characteristics data – that allow for numerical analysis and comparisons • Qualitative data: non-numerical information usually in narrative format – like findings from a focus group – that provide depth and context • Large-sample data from PLWH that provide findings “representative” of the population sampled

Useful Methods: Surveys Often used to: • Assess PLWH or consumer service needs, experiences, barriers, and gaps • Obtain data from service providers • Reach large numbers of people, with sampling to obtain findings that represent the entire population sampled Design and implementation: • Mostly “forced-choice” questions so responses can be tabulated • Often provided on a tablet or via Internet for easy tabulation – though paper surveys can be used

Useful Methods: Focus Groups Often used to: • Obtain information about service experiences, needs, gaps, and barriers for a set of particular groups of PLWH • Gain in-depth understanding of needs of key populations • Obtain information relatively quickly and at moderate cost Design and implementation: • Open-ended questions for discussion, often as part of a “script” for the facilitator, often with a quick survey on participant characteristics • Usually involves a small group of individuals (6-12) from the same target population • Requires careful notetaking

Useful Methods: Town Halls or Community Forums Often used to: • Meet legislative requirements for community – especially PLWH – input to decisions about funding and services • Provide an open forum in several locations within the EMA or TGA to invite input and report back to the community Design and implementation • Sometimes open-ended, with individuals signing up to make a brief (3-5 minute) presentation to PC/PB leadership • Sometimes structured around specific questions for discussion • May ask participants to vote on their top service priorities

Other Needs Assessment Methods • Provider forums: similar to a town hall or community forum but designed to obtain input from service providers, RWHAP-funded and non-funded • Key informant sessions: similar to a focus group in size, but designed to generate discussion with experts (providers, consumers, researchers) about a particular service category or model, or the needs of a specific population • Key informant interviews: individual interviews with purposes similar to key informant sessions • Special studies: focusing on a service category, population, barrier to care, or other issue and often using a combination of existing and new data

Using a Multi-Year Needs Assessment Cycle and Plan • Sound practice: multi-year needs assessment cycle • Epi Profile must be updated each year – and included in the annual RWHAP Part A application • Resource Inventory should be reviewed annually to identify new resources or service gaps • Other components, such as the PLWH survey or Profile of Provider Capacity and Capability, often updated on a 3-year cycle – so no data are more than 3 years old

Value of a Multi-Year Plan • Helps the responsible committee plan its work and determine when a contractor may be needed • Allows for multi-year PC/PB budget planning – more funds may be needed in years of major needs assessment activity such as a PLWH survey • Helps the PC/PB negotiate a realistic budget amount with the recipient to include in the annual application • Helps ensure that needs assessment is well planned and implemented, with reasonable deadlines

Developing a Multi-Year Plan • Plan for one major needs assessment activity each year, plus some smaller efforts, for example: • PLWH survey Year 1, special study on unmet need Year 2, profile of provider capacity and capability Year 3 • Focus groups with key populations and/or key informant groups or interviews Year 2 or 3 • Town hall or community forum every year • Be sure the cycle addresses annual deadlines, with findings available for: • Data presentation at beginning of the PSRA process • Use in preparing the annual application

Developing a Multi-Year Plan (cont.) • Try to leave a little unassigned needs assessment time/resources – flexibility to add a special study or explore an emerging issue • Identify resource requirements for planned tasks • Estimate required time and effort by PC/PB support staff • Identify assistance needed from recipient staff – to ensure subrecipient cooperation in data gathering, help in obtaining access to secondary data, help with data analysis • Consider any requests for surveillance staff beyond the normal epi profile • Determine whether a consultant, contractor, or university partnership is needed

Needs Assessment Step 1 • Plan for the needs assessment • Determine the scope of the needs assessment – ideally, based on an existing multi-year plan & cycle • Determine the timetable • Develop the budget and ensure needed funds are available in the PC/PB budget • Agree on responsibilities for conducting and overseeing the needs assessment, including whether a consultant or contractor is needed – and begin the contracting process • Include a process for community input each year

“Staffing” the Needs Assessment Options include: • PC/PB support staff • Recipient staff with strong data skills • A research expert who serves on the PC/PB or committee • A university partner – e.g., involvement of graduate students, interns • PC/PB members and committee members • Consumers and other PLWH who are not members • A contractor or individual consultant

Issues in Needs Assessment “Staffing” • PC/PB staff typically coordinate and oversee needs assessment • In smaller jurisdictions, staff may not have needed time or specific planning skills • PC/PB members and committee members can help, but often have limited time • Many EMAs and TGAs hire consultants to help, if funds can be made available • Good planning and supervision can help control needs assessment consultant or contractor costs • PC/PB support staff usually provide day-to-day supervision

Needs Assessment Step 2 • Design the needs assessment methodology • Determine what information is available and what new data must be collected • Select the methods to be used • Involve a research expert to ensure sound process • Develop data collection tools – with input from the consumer committee or caucus • Translate tools into additional languages as needed • Develop a plan for aggregating and analyzing the data • Decide how to present and use results • Involve all partners in developing and/or reviewing the process

Needs Assessment Step 3 • Gather the information required for the needs assessment • Arrange to receive epi data from surveillance staff (state or local) in needed formats • Obtain and review other existing information – from surveillance, recent needs assessments, the recipient, providers involved in research • Arrange for recipient help in ensuring subrecipient cooperation for accessing consumers or staff • Train data collection personnel • Collect new data • Provide assistance to individuals with special needs

Needs Assessment Step 4 • Analyze findings and present results • Clarify key questions to be answered • Review how data from each source will be used • Decide how and by whom data from each method will be tabulated (if quantitative) and analyzed • Agree on how data will be summarized (Report? PowerPoint presentation?) and presented (A PC/PB meeting? A combined data presentation?) • Identify or develop user-friendly formats for presenting findings

Maximizing Consumer Involvement in Needs Assessment • Recruit consumers to serve on the committee responsible for needs assessment – include both PC/PB members and non-members • Involve the consumer committee or caucus in tool development • Ask the committee to review questions and response categories, to see if anything is missing or unclear • Have committee members pre-test the tools designed for PLWH

Maximizing Consumer Involvement in Needs Assessment (cont.) • Train consumers to help gather data • Facilitate focus groups or key informant sessions • Chair or facilitate town halls or consumer forums • Administer online or paper surveys • Identify and recruit consumers from targeted PLWH populations to complete a survey or attend a town hall • Ask consumers to help interpret findings • Encourage consumers serving on the PC/PB and committees to provide needs assessment input • Attend town halls or consumer forums • Complete PLWH surveys [Note: Focus groups should target people who would not otherwise have input]

Controlling Needs Assessment Costs • Partner with other RWHAP Parts in planning and implementing needs assessment – e.g. use a shared PLWH or provider survey (add some local questions if needed) • Obtain tested needs assessment tools from similar EMAs or TGAs – most are happy to share • Train consumers to help gather data • Cooperate with non-RWHAP providers – e.g., ask HOPWA to arrange for residents of its housing to complete a survey

Prevention/Care Needs Assessment • Unified planning bodies may want to include all aspects of HIV prevention and care in needs assessment • Some prevention needs assessment involves separate efforts targeting individuals who are not HIV-positive • Costs can be an issue where no funds are available for prevention-focused needs assessment or to help with PC/PB support • Many aspects of HIV prevention can become a part of integrated needs assessment efforts

Integrated Prevention/Care Needs Assessment Strategies • Include prevention providers in the Resource Inventory and Profile of Provider Capacity and Capability • Include questions in PLWH surveys on topics such as: • Prevention for positives – prevention service needs, experiences, barriers, and gaps • Stigma and its impact on testing and linkage to care • Knowledge about HIV transmission, viral suppression, PrEP, and nPEP • Other topics that are a priority for state or local Health Department prevention staff

Integrated Prevention/Care Needs Assessment Strategies (cont.) • Ask recently diagnosed individuals responding to PLWH surveys about: • Level of HIV knowledge prior to diagnosis • Prior participation in HIV prevention interventions • HIV education provided following diagnosis • Testing experiences • Post-testing and linkage to care experiences, including counseling and partner contacts • Add focus groups for individuals from target populations who are not HIV-positive

Analyzing and Presenting Needs Assessment Findings • Analyzing Needs Assessment Findings • Integrating Data from Multiple Sources • Presenting Findings

Analyzing Needs Assessment Findings: Qualitative Data Review and summarize qualitative data from focus groups, town hall meetings, key informant sessions or interviews: • Focus on identified key questions • Describe areas of agreement and disagreement • Highlight unexpected findings, new trends • Keep reports concise • Organize by topic • Use plain language • Protect anonymity of participants

Analyzing Needs Assessment Findings: Quantitative Data For quantitative data from surveys or other sources: • Enter data into SPSS (data analysis software) or Excel, or use online survey analysis tools • Review data for completeness and “clean” the data as needed • Do initial tabulations by question and review responses • Separately tabulate, analyze, and compare data based on factors such as race/ethnicity, age, gender/gender identity, risk factor, place of residence, and co-occurring conditions • Conduct additional analyses based on key questions • Discuss and interpret findings in committee

Use to Address Key Questions • What core medical & support services are needed and by whom? • What services are being provided? • What service gaps remain—overall? for particular groups of PLWH? • What barriers are discouraging PLWH from entering and remaining in care, adhering to medications, and reaching viral suppression? • What disparities are there in availability, accessibility, and/or appropriateness of HIV services for particular populations and/or geographic areas? • What was suggested to fill gaps and better meet needs, overall and for specific populations?

Making the Most of Your Survey Data Do not limit the value of your survey data through limited analysis • Be sure to separate and compare quantitative findings by key factors such as race/ethnicity, gender/gender identity, age, geographic residence • Often there are large differences in services, needs, barriers, and gaps based on such factors • Use multiple filters to look at several factors at once – for example, look at data for young MSM of color • Sophisticated computer programs and analytic skills are not required: even inexpensive online survey tools will let you “filter” responses in this way

Making the Most of Your Survey Data (cont.) • If 25 or more individuals from an important target population responded to your survey, separately review those data and compare findings on key questions • If you asked about characteristics and conditions like homelessness or unstable housing, country of birth, recent incarceration, substance use, mental health issues, or other health conditions like diabetes, separately analyze data for people reporting each characteristic • Findings cannot be assumed to represent the entire subpopulation, but are valuable – it is like having several focus groups but with more specific data

Integrating Data from Several Needs Assessment Sources Compare findings from different components of the needs assessment – for example: • Compare PLWH and provider views about the most serious service gaps and barriers to care • Compare focus group findings on a specific population with survey data on the same population • See if trends reflected in your epi profile are mentioned in focus groups, town halls, or special studies

Integrating Data from Other Sources • Compare consumer data from the needs assessment with consumer data from the recipient, such as: • Client characteristics and service utilization data – usually available by race/ethnicity, gender/gender identity, age, and risk factor • Cost data by service category • For example, if some populations in your PLWH survey or focus groups say they find it hard to obtain particular services: • Do utilization data indicate that these populations are under-represented as users of these services? • Were all funds for these service categories expended?

User-Friendly Data Formats • Summarize findings in brief report(s) or presentation slides • Include understandable graphics • Present data in terms of both numbers and percent • Include a concise text explanation for each chart • Use creative formats to summarize and compare data from different sources • Always provide information needed to assess the quality of findings – e.g., number of responses, sampling approach, limitations in data gathering, problem questions • Test formats on new members including consumers

Year-Round Presentation of Findings • Present findings from individual components of your needs assessment as soon as data are ready – don’t wait for the annual data presentation • Present first to the responsible committee • Then to the PC/PB as a whole • Make a special presentation for the consumer committee • Frequent presentations, with mini-trainings on understanding and using data: • Provide information that can be used during the year • Add interest to meetings • Help PC/PB and committee members become comfortable reviewing data

Annual Data Presentation • Occurs in late spring, just before priority setting and resource allocation begins • Includes presentations on epi data, needs assessment findings, and other data from the recipient • May also include individual input from consumers and/or service providers • Sometimes agenda allows individuals to sign up to make 3-5 minute presentations • As an alternative, individual input can be obtained earlier through town hall meetings or community forums, with a summary provided at the data presentation

Annual Data Presentation (cont.) • Most successful where much of the information has already been discussed at a prior PC/PB meeting, and focus can be on comparing findings from different sources • Presentations should be reviewed by the responsible committee – including consumers – to ensure clarity, conciseness, understandable charts, and highlight new or unexpected issues or findings • Presentations should be sent out before the meeting to allow time for prior review

Sum-Up • Needs assessment should involve: • An ongoing cycle and a multi-year plan • Use of several methods and multiple data sources • Analysis that goes beyond tabulation of data for all PLWH to include findings and comparisons by subpopulation • Needs assessment costs can be controlled with good planning and collaboration • Annual needs assessment activities need to be completed in time for use in PSRA and inclusion in the annual RWHAP Part A application • But findings should be presented throughout the year

Optional Slides for Activity

Instructions for Activity: Outlining a Needs Assessment Work Plan • Work in a small group and choose a facilitator, a recorder, anda reporter • Individually review the Situation and Work Sheet, then work as a group • Use the information from the training and your own experience to prepare a preliminary work plan for this PC/PB’s Needs Assessment Committee • Use the situation provided, making any other needed assumptions • You have 30 minutes – then your reporter will discuss your work with the full group

Needs Assessment