Enhancing HIV/AIDS and Substance Abuse Prevention in Minority Communities

1. Integrating HIV/AIDS and Substance Abuse Prevention in Minority Communities: A U.S. National InitiativeFunded by the Substance Abuse and Mental Health Services Administration,Center for Substance Abuse PreventionLucille Norville Perez, MD Fabian Eluma, MDJSI Research & Training InstituteProject Coordinating Center

2. Understanding Client Needs:Baseline Risk Factors Thomas W. Mangione, Ph.D. Rodolfo Vega, Ph.D. Anita Raj, Ph.D. Hortensia Amaro, Ph.D. Kim Watson Lucille Perez, M.D.

3. Goals of Initiative • To increase capacity in minority communities to prevent HIV and/or substance abuse • To deliver prevention services to African-American women and Hispanic Women • To deliver prevention services to minority youth • To identify effective mechanisms to deliver prevention services to these communities.

4. Research Design • Baseline, 3 month follow-up, 9 month follow-up • Constructed comparison groups • Scannable, Self-Administered surveys • Adult, Youth (13+) & Children’s versions • Translated into Spanish • Program staff available to help complete survey if needed • Centralized Processing for Scanning, Cleaning Data

5. Additional Types of Data Being Collected • Process Data on # persons serviced and types of services • Yearly site visits • Client focus groups in some sites • Cost Data for delivery of service units • Access Capacity for Providing Services both Directly and through Other Community Agency Linkages

6. Baseline Data Status • 3 Different Baseline Groups of participants • Adults • Youth (13+) • Children • Before Study is finished we expect between 1000-1500 baseline surveys for participants and similar n’s for comparison groups • Today’s presentation based on 1000 youth & 1000 women combining participants & comparison group members • Additional baseline and follow-up data is being collected • Additional completed surveys are being cleaned • Today’s data should be considered preliminary

7. Racial/Ethnic CompositionAdult Women

8. Have Children Under 18 Adult Women

9. Racial/Ethnic CompositionYouth

10. Gender CompositionYouth

11. Age Distributionfor Girls & Boys

12. Women’s Drug Use In Past 30 Days Rates calculated to include entire sample in denominator. * This number was changed after APHA 2001 presentation.

13. Women’s Sexual Risk Taking Behaviors - Past 30 Days (of sexually active) * Calculated to include entire sample in denominator.

14. Women’s Perceptions of “Great Risk” When Having Sex with Other Partners or Sharing Needles

15. Youth Alcohol & Drug UseIn Past 30 Days Rates calculated to include entire sample in denominator. * This number was changed after APHA 2001 presentation.

16. Youth Sexual Risk Taking Behaviors In Past 30 Days (among sexually active) * Calculated to include entire sample in denominator.

17. Youth Perceptions of “Great Risk” for Sexual & Drug Use Behaviors

18. SAMHSA/CSAP Initiative is Providing HIV & Substance Abuse Preventionin Minority Communities at Risk

20. Integrating HIV and Substance Abuse Prevention Programs: How Racial/Ethnic Minority Communities are Meeting the Need Anita Raj, Ph.D. Rodolfo Vega, Ph.D. Thomas W. Mangione, Ph.D. Jacqueline J Nolan, MPH Maya Y Mauch, MPH Lucille Perez, M.D.

21. Process Evaluation • Goals were to determine: • What strategies, supports, and resources are necessary for agencies to implement HIV and Substance Abuse Prevention programs for women and youth • What strategies, supports, and resources are necessary for community-based agencies to participate in a cross-site program evaluation

22. Process Evaluation • Research Questions: • What do programs look like? • What recruitment and retention strategies work for different populations? • How are participants responding to the program? • What has facilitated or hindered agencies when engaging in program evaluation?

23. Research Methods • Quantitative and Qualitative data collection methods • Intervention data from quarterly report • Site visits • Monthly technical assistance calls

24. Presentation Objectives • Describe intervention strategies used by different population-based programs • Describe recruitment and retention strategies and how special populations are reached • Describe challenges for program development, implementation, and evaluation • Describe characteristics that facilitate successful program implementation

25. Populations Served • 25 Youth-Focused Sites • 11 Women-Focused Sites • 7 Family-Focused Sites • 4 Other Sites • indicative of multiple populations served • 3 of these sites include men

26. Youth Programs Women Programs Family Programs Education and Skills Training 13% 15% 6% Multi-session Groups 17% 15% 17% Single Session Groups 16% 9% 6% Individual Risk Reduction Counseling 8% 7% 4% Street Outreach 10% 11% 6% Intervention Strategies

27. Youth Programs Women Programs Family Programs Case Management 4% 4% 8% Mental Health/ Support Groups 8% 9% 25% Community Building 15% 9% 3% Other 9% 21% 25% Intervention Strategies

28. Successful Recruitment Strategies • Make services accessible to communities where they are: • Community Centers • Home visits • Street Outreach • Mobile Approaches • Deliver educational messages using peer approach • Referral from family, friends, and other service agencies • Provide services in other organizations that have access to clients • Provide intervention in a safe space without judgement and expectations • Develop a trusting relationship with the community

29. All Peer driven Recognition of Participants High Program stability Culture, Gender, Developmental Competence Youth Parent supported Women Childcare and Transportation Family provide family activities Characteristics of Programs with Strong Retention

30. Challenges to Program Development: Curriculum Development • Developing HIV and Substance Abuse prevention integrated curricula was challenge • Programs brought varying levels of expertise in curriculum development • Culturally tailoring programs was a necessary and time-consuming process • Developing mechanism for documenting curriculum changes remains a challenge

31. Challenges to Program Implementation: Staff Turnover • Staff Turnover was often high • Often funded for part-time jobs, resulting in overworking of employee or inability to fill position • Training and continuing education not included, minimizing opportunity for advancement • Salaries and benefits not strong • Work itself is mentally draining, and some programs have no built in support systems for their staff

32. Challenges to Program: Inadequate Infrastructure • Infrastructure of agency was often not prepared for increased funding • SAMHSA funding provided a huge increase in agency budget, and many agencies did not have structure to manage budget of this size. • Inadequate MIS systems were common • difficult for sites to manage new budget • communication difficulties with PCC and other sites (within program and outside program) were common • staff were often not available and/or sufficiently trained to manage current MIS systems

33. Challenges to Evaluation • The GFA did not make explicit the requirement of a cross-site evaluation • Many grantees were unfamiliar with the IRB/FWA/COC processes • FWA rules changed during processing • Many grantees were unfamiliar with evaluation methodology and requirements • Evaluation-related challenges resulted in delays in program implementation

34. Conclusions • Despite significant challenges, programs have been able to develop and implement integrated HIV and substance abuse prevention programs focused on women, youth, and families. • Program strategies are tailored to the unique needs of target populations • Youth and Women Programs focus more on HIV and Substance Abuse intervention solely • Family Programs focus on more holistic related issues, including mental health and group support • Culture-tailoring is an integral part of program development.

35. Conclusions • Recruitment strategies are similar across groups, relying on captive groups, referral, and outreach. • Retention strategies are also similar across groups and primarily relate to increasing strength of program (e.g., program stability, recognition and involvement of participants). • Needs of Special Populations (gay youth, street youth, homeless, substance abusers) are primarily reached by providing a safe, nonjudgmental place in which education and skills can be gained.

36. Conclusions • Major support is needed for programs to be able to accomplish this work. • This support must include • Assistance with Curriculum Development and Documentation of Curriculum Changes • Adequate Staff Resources to minimize Staff Turnover • Adequate Support for Agency Infrastructure changes required by initiatives such as the MAI • Training and Support for Evaluation

38. Getting Ready to Implement and Evaluate: Lessons Learned Jacqueline J Nolan, MPH Maya Y Mauch, MPH Dianne Perlmutter, MSW, MPH Patria Rojas, MSW, MPH Leslie Roberts, MPH Lucille Perez, M.D.

39. Overview • One component of the SAMHSA Integrated HIV/AIDS and Substance Abuse Targeted Community Capacity Initiative is to provide technical assistance (TA) to the 47 funded programs • TA needs ranged from program implementation to program evaluation. • Most TA provided was in the area of evaluation.

40. Technical Assistance • The TA section of today’s panel discussion will profile: • The programs: settings, target population, and curricula • The TA framework • The TA needs of the programs • The TA strategies used to address the needs of the programs

41. Programs’ Settings • Health Centers/Hospitals • Community Wide • Homes • Housing Developments • Shelters • CBO • ASO • Community Centers • Street Outreach • Schools • Head Start • Churches/Faith Based • Prisons

42. Target Population

43. Examples of Science-Based Curricula Used by the Programs • ASK US • Be A Responsible Teen (BART) • Be Proud Be Responsible • Education Now And Babies Later (ENABL) • Family Strengthening Programs • Focus on Families • Life Skills and HIV • Prochaska Trans Theoretical Model • Safety Net

44. The Technical Assistance Framework • Building and maintaining a trusting relationship • Maintaining and delivering TA through regular communication and contact with the programs • Developing an in-depth understanding of the proposed intervention, the program, the affiliated agency/organization, and the evaluation plan • Developing a technical assistance plan

45. Building and maintaining a trusting relationship • Acknowledge the program’s expertise, experience and commitment to the work • Assess the program’s knowledge and perception of research and evaluation • Frequent check-in calls • Clarify and reinforce the goals and purpose of the technical assistance

46. Developing an in-depth understanding of all aspects of program • What is the intervention model or design? • What science-based curriculum is being used? • How has the intervention design changed from the original proposed plan? • How has the intervention or curriculum been modified to be culturally relevant/appropriate? • What is the evaluation plan and design? • Staffing structure • What partnerships or collaboration have been developed as a result of this program? • Location of program within the organization • How has agency capacity increased as a result of this program?

47. Frequent communication and contact with the program • Using the “dental” approach (frequency of contacts/proactive vs.. reactive) • Using a diverse array of modes of communication including, the listserv, telephone, website, fax, and face-to-face site visits • Cluster meetings within states or regions • Grantee meetings/steering committee meetings

48. Development of a technical assistance plan • Developed jointly between program and technical assistance coordinator • Framed within the context of the goals of the overall project • Incorporating local and national resources to support the technical assistance plan

49. Technical Assistance Needs of the Programs: • Development, adaptation, and documentation of curriculums integrating HIV/AIDS and Substance Abuse prevention • Recruitment and retention of program staff • Service delivery issues • Outreach and recruitment of clients • Development of adequate job descriptions • Building and maintaining collaborative relationships • Development of capacity and infrastructure in the areas of MIS and fiscal monitoring • Development of increased understanding of the federal funding and reporting procedures

50. Evaluation TA Needs of the Programs • Developed an increased understanding of the need for and purpose of an internal review board (IRB), federal-wide assurance (FWA), and a certificate of confidentiality (COC). • Developed an understanding of comparison group issues • Supported data collection via survey administration