Monitoring Healthy Relationships:

1. Presentation slides available at www.effectiveinterventions.org • Select Health Relationships, • Select HR Resources and Tools Monitoring Healthy Relationships: A Small Group-level Intervention for People Living with HIV/AIDS Web Conference: February 23, 2006 Miriam E. Phields, PhD Science Application Team, Capacity Building Branch Division of HIV/AIDS Prevention National Center for HIV, STDs, TB Prevention Centers for Disease Control and Prevention

2. Objectives • To provide a brief overview of Healthy Relationships (HR) intervention and CDC training on HR • To discuss the resources and training needed to implement the intervention • To discuss strategies and methods for conducting contract monitoring and quality control for CBOs implementing the HR • To introduce an optional tool for monitoring HR implementation

3. Goals of the Healthy Relationships Intervention • To reduce sexual risk behaviors of men and women living with HIV/AIDS • To reduce HIV-related stress

4. Overview of the Healthy Relationships Intervention • Evidence-based • People living with HIV/AIDS • Small groups • Five sessions • Develop coping skills to manage stress and to improve decision-making skills

5. Healthy Relationships Training • Four-day training • Facilitators are strongly encouraged to attend. • Program managers/coordinators may also attend. • Sign up at www.effectiveinterventions.org • CDC will provide the trainers and the intervention packages • HDs provide the training space and A/V equipment

6. Healthy Relationships Trainings Sponsored by CDC • From Jan. 1, 2005 to Dec. 31, 2005: • 29 trainings • 470 participants • 193 agencies • 129 CBOs (340 staff) • 32 HDs (63 staff) • 32 Other (CBAs, PTCs, Univ) (67 staff)

7. Healthy Relationships Intervention Materials • Distributed to training participants only • Bag contains • Implementation Manual • Technical Assistance Guide • Marketing and Educational Videos • Session Envelopes • Risk Continuum Banner • Information sheet • Electronic version of forms • Does NOT include any of the movie-quality clips

8. Costs of HR • Use the Cost Worksheet to develop a budget (see HR Starter Kit pp. 7-9) • Figures are based on one implementation of the complete intervention to one target population. • Costs will depend on: • Costs in a particular area • Staff turnover • Number of cycles of the intervention (one cycle = 5 sessions) • The number of peer facilitators who will be needed for each cycle delivered to a different target population.

9. Monitoring Effective Behavioral Interventions • To systematically check the progress, content, and quality of the planning, implementation, and evaluation of an effective behavioral intervention • To assess progress and completion of contractual agreements and deliverables (e.g., performance indicators, services, etc.) • To assess technical assistance (TA) needs • To provide TA and other support to implementers

10. 10 Domains for Monitoring the HR • Pre-implementation Activities • Facilitators • Administrative Items • Location and Materials • Policies and Procedures • Adaptations • Participants • Session Format • Implementation Activities • Quality Assurance and Evaluation

11. Pre-implementation Activities • Is HR an appropriate intervention for the CBO? • Agency capacity (e.g., adequate resources including staff, space, money, access to target population) • Target population (e.g., risk behaviors, behavioral determinants)? • Has an assessment been conducted with target population?

12. Pre-implementation Activities (con’t) • Implementation plan developed • sample on www.effectiveinterventions.org • Logic model developed • sample on www.effectiveinterventions.org • Recruitment plan developed • including how to sort people into groups and administer Initial Assessment Survey (IAS)

13. Pre-implementation Activities (con’t) • Retention plan developed • Stakeholders identified and contacted • Advisory group established and meetings held as planned (e.g., monthly, quarterly, etc.) • Intervention materials reviewed and approved by the Program Review Panel

14. Pre-implementation Activities (con’t) • Facilitation and coordination sessions planned by co-facilitators • Facilitators practiced sessions before conducting HR with consumers/participants • Debriefings planned • Referral plan created and tested

15. Facilitators • Two facilitators per group • One facilitator, who is a mental health professional or experienced counselor, has been hired or volunteered • One facilitator, who is a peer for the targeted audience and living with HIV/AIDS, has been hired or volunteered • Both facilitators have group facilitation experience/training.

16. Facilitators (con’t) • At least one facilitator is living with HIV/AIDS • At least one facilitator matches target population • All facilitators completed the CDC’s HR course

17. Total number of facilitators will depend on the number of groups delivered to different target populations For example: Women’s group MSM group Heterosexual men’s group Peer Fac. MSM Group MH Fac. Women’s Group Heterosexual Men’s Group Peer Fac. Peer Fac. Facilitators (con’t)

18. Administrative Items • Job descriptions prepared • Organizational chart prepared • Regular staff meetings held and topics/discussion documented • New staff orientation developed and documented • Licenses/certifications verified • Personnel folders complete

19. Location and Materials • Easily accessible location for sessions • Private room large enough for sufficient number of chairs to be arranged in circle with TV/VCR/DVD • TV/VCR/DVD with remote control • Easel Chart Guides created • Easels, easel pads and markers obtained • Movie clips selected that are appropriate for group members • Movie clip intervention tape created

20. Location and Materials (con’t) • Initial Assessment Survey (IAS) completed for all participants • Personal Feedback Reports (PFRs) made from IAS for each participant • PFR posters created • Resource Packets prepared • Condoms and anatomical models obtained • Refreshments planned and obtained • Incentives determined and obtained

21. Policies and Procedures • Confidentiality policy • HIV in the Workplace policy • Staff and participant illness policy • Data security procedures • Attendance policy (especially for Session Two) and closed group • Visitor/observer policy • Legal policies (state disclosure laws and duty to warn) • Mandatory Reporting policy (e.g., abuse, intent to harm, etc.)

22. Policies and Procedures (con’t) • Participant consent or release of HIV-related information form and signing process • Volunteer policy for peer facilitator • Incentive monitoring policy • Adverse event and crisis management procedure • Mental health professional/experienced counselor facilitator’s responsibilities policy • Peer facilitator’s responsibilities policy • Participant eligibility policy • Client grievance policy prepared and displayed • Recruitment policy and screening procedure

23. Adaptations • Documentation of all changes to key characteristics and other adaptations • Formative evaluation and assessment to validate need for adaptation has been conducted. • Advisory Group consulted • Revisions made to HR logic model to describe adapted intervention • Revisions made to HR implementation plan to match adapted intervention • Marketing materials adapted

24. Adaptations (con’t) • Number, length, or frequency of sessions adapted, if necessary • Refreshments adapted, if necessary • Incentives adapted, if necessary • Risk Continuum Cards revised • IAS revised • PFRs (including posters) revised • Easel Chart Guides revised and prepared with set-the-scenes that match clips chosen • Appropriate clips chosen for target population and each “type” of group (e.g., women’s group, MSM group, heterosexual men’s group)

25. Participants • Living with HIV/AIDS only • Narrowly defined target population • Groups divided by gender and sexual orientation • Small groups of 5-12 people • No couples in group • Policy about sexual contact with other group members during group • Age 18 and over • Sufficient recruitment has been conducted to fill the groups (5-12 people)

26. Session Format • 5-6 sessions maximum • All sessions follow the Facilitators’ Session Outlines • Sessions are 120 minutes long or adapted for population • 2 facilitators (1 mental health professional/ experienced counselor and 1 peer) conducted sessions

27. Implementation Activities • Facilitation and coordination sessions conducted by co-facilitators • Debriefings held • Participant-specific session notes are documented • Attendance documentation (date, session #, names of participants) is available • Client records kept locked and with limited access

28. Implementation Activities (con’t) • Core elements implemented with fidelity: • Defining stress and reinforcing coping skills across three life areas—disclosing to family and friends, disclosing to sexual partners, and building healthier and safer relationships. • Using modeling, role-play, and feedback to teach and practice skills related to coping with stress. • Teaching decision-making skills about disclosure of HIV status. • Providing personal feedback reports to motivate change of risky behaviors and continuance of protective behaviors. • Using movie clips to set up scenarios about disclosure and risk reduction to stimulate discussions and role-plays.

29. Quality Assurance and Evaluation • A quality assurance plan has been developed that includes session observations and record reviews and dates for implementation • The quality assurance plan is implemented and results reviewed by program manager in timely manner • A participant satisfaction survey is administered annually and results reviewed by program manager • An evaluation plan has been created • The evaluation plan has been implemented

30. Quality Assurance and Evaluation (con’t) • Evaluation forms have been developed • A database has been created and data entered • Data are analyzed periodically and reports generated • Reports are reviewed periodically by program manager • Evaluation data used to improve program • Quality assurance, evaluation, and participant satisfaction results are used to make adjustments to the implementation of HR

31. Monitoring Tool for Healthy Relationships Implementation • OPTIONAL • Downloadable Word document • May be revised, added to, changed in any way for your use • Monitoring tool available at www.effectiveinterventions.org • Select Healthy Relationships • Select Resources/Tools

32. Snapshot of Monitoring Tool for Healthy Relationships

33. Questions and Answers • Presentation slides available at: • www.effectiveinterventions.org • Select Health Relationships • Select HR Resources and Tools